"Systemic capillary leak syndrome (SCLS) is an extremely rare disease of unknown incidence. Typical manifestations of SCLS include hypotension, edema, hemoconcentration, and hypoalbuminemia after nonspecific prodromal illnesses. Increased capillary vascular permeability is the commonly accepted pathophysiology. However, the exact pathogenesis remains unclear...
... We describe a case of SCLS after Ad26.COV2.S vaccination in a patient with smoldering multiple myeloma.
A 38-year-old man reporting vomiting and dizziness sought treatment at an emergency department. Smoldering multiple myeloma had been diagnosed 1.5 years before, but no laboratory abnormalities had been found in his most recent hospital visit 5 months earlier. He had received the Ad26.COV2.S vaccine 2 days before the emergency department visit and experienced fever, chills, and myalgia 12–24 hours postvaccination, then nausea, recurrent vomiting, and general weakness 24–48 hours postvaccination. At admission, he was afebrile, his heart rate was 130 beats/min, and his blood pressure was100/90 mm Hg, with no noticeable edema...
We believe a life-threatening flare developed after COVID-19 vaccination in the patient in our study who had a history suggestive of SCLS. Clinical findings were compatible with a previous report in which life-threatening disease occurred 1–2 days after vaccination; we could identify no SCLS triggers other than receiving the COVID-19 vaccine. Data from a review article indicated that 44% of 134 patients had identifiable SCLS triggers; 88% of those were infections, usually respiratory, and 11% involved intense physical exertion or extended travel. There was also a case report of possible SCLS related to the influenza vaccine; although not clearly meeting all the criteria for SCLS, a peritoneal dialysis patient experienced recurrent episodes of hypotension, peripheral edema, and hypoalbuminemia after 2 consecutive seasons of influenza vaccination. Immunologic response to vaccination has been proposed as a possible mechanism, but further studies are needed to verify factors predisposing patients to SCLS after COVID-19 immunization."