Lower Extremity Compartment Syndrome due to Capillary Leak Syndrome following 60% Total Body Surface Area burn injury.

Abstract

Background: Lower extremity compartment syndrome (LECS) following burn injury in the absence of circumferential burns is rare. Capillary leak syndrome (CLS) is a condition characterized by systemic capillary hyperpermeability and can be triggered by the multisystem inflammatory response seen in extensive burns. The resulting intravascular fluid loss into the interstitial space can elevate compartment pressures and contribute to the development of compartment syndrome. In the case presented here, the patient developed LECS in the setting of severe burn injury with clinical and laboratory evidence consistent with CLS, suggesting increased capillary permeability as a key pathogenic factor.

Methods: This case was managed in accordance with the Declaration of Helsinki (2013). IRB approval was not required per institutional policy. Written informed consent for treatment and publication was obtained from the patient's legal guardian, and all identifying details were removed.

Summary: A 20-year-old male with a one-pack-per-day smoking history and no other medical history was admitted to the burn ICU following a house fire. He sustained 60% total body surface area (TBSA) superficial partial-thickness, deep partial-thickness, and full-thickness burns involving both upper and lower extremities, back, neck, and face, along with inhalation injury. Shortly after admission, he developed hemodynamic instability, managed with intravenous fluids, blood products, and vasopressors, resulting in initial stabilization. On hospital day three, the patient developed LECS that was successfully treated by emergent bilateral four-compartment fasciotomies.

Conclusion: We describe a patient who developed LECS secondary to burn injuries, CLS, and aggressive fluid resuscitation. Patients with large TBSA burns and inhalation injury are at elevated risk for burn shock and multiorgan dysfunction, leading to significant morbidity and mortality. We explore the underlying pathophysiological mechanisms linking severe burns, CLS, and the development of compartment syndrome.