Elevated endothelial activation biomarkers such as von Willebrand factor and angiopoietin-2 were observed in patients with severe CRS in association with endotheliopathy and coagulopathy.[15–17] Elevated IL-6 production increased vascular endothelial permeability through VE-cadherin disassembly and C5a receptor expression, leading to vascular leakage.[17,18] Lymphatic vessels share structural similarity with blood vessels. This evidence concerns the gene IL6 and congenital rubella syndrome.