Ver el código de «Cytokine release syndrome»

==Background==
*Systemic inflammatory response syndrome that can be adverse effect of certain immunotherapies, such as monoclonal antibodies and CAR-T therapies (e.g. CART19 for [[leukemia]])
*Pathophysiology and presentation similar to [[sepsis]]
*Severity ranges from mild flu-like illness to severe sepsis-like inflammatory response with shock, vascular leakage, DIC, and multi-organ system failure<ref>Shimabukuro-vornhagen A, Gödel P, Subklewe M, et al. Cytokine release syndrome. J Immunother Cancer. 2018;6(1):56.</ref>

==Clinical Features==
*Mild: [[flu-like illness]]
**[[Fever]], [[headache]], and/or [[myalgia]]
*Severe: mimics [[septic shock]]
**[[Fever]], [[tachycardia]], [[hypotension]], [[dyspnea]], [[hypoxia]]
**Organ-specific dysfunction: [[encephalopathy]], [[coagulopathy]], [[renal failure]], [[CHF]]

==Differential Diagnosis==
*[[Sepsis]]!
*[[Hemophagocytic lymphohistiocytosis]]

{{Shock DDX}}
{{Oncologic emergencies DDX}}

==Evaluation==
''Hospitals administering CAR-T therapies will often have very specific guidelines for initial workup''
*Immunocompromised infection workup: see [[neutropenic fever]]
*Evaluate for [[tumor lysis syndrome]]
*Labs to screen for organ dysfunction: CBC, BMP, [[LFTs]], [[DIC]] labs

==Management==
*Strongly consider discussion with CAR-T treatment team
*Empiric [[antibiotics]] (assume sepsis until proven otherwise)
**See [[immunocompromised antibiotics]], [[sepsis]]
*Treat [[shock]]
*[[Corticosteroids]] for severe cases
*Consider Tocilizumab (IL-6 receptor antagonist) in consultation with oncology

==Disposition==
*Admit or consider transfer to hospital with oncology

==See Also==


==External Links==
*https://www.mdcalc.com/cytokine-release-syndrome-crs-grading#evidence
*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003181/

==References==
<references/>
[[Category:Heme/Onc]]