A CASE OF INTERMITTENT HEMOPTYSIS: THE SPECTRUM OF ANTIPHOSPHOLIPID ANTIBODY SYNDROME

Abstract

TYPE: Late Breaking Case Report TOPIC: Pulmonary Manifestations of Systemic Disease INTRODUCTION: A 46 year old WM presented with several years of intermittent hemoptysis. Symptoms resolve spontaneously, improve with diuresis or required antibiotics/steroids. Evaluation for infection was negative and was maintained on daily prednisone with benefit. Malaise, hypoxemia, edema with hemoptysis but no other associated symptoms. CASE PRESENTATION: Past medical history includes CVA at age 24 related to antiphospholipid antibody syndrome and treated with anticoagulation. No other organ involvement reported. Medical history: CKD, HTN, non-ischemic cardiomyopathy. Remote 15PY tobacco history, no other exposures. On exam, room air O2 saturation 92%, desaturation to 70s with exertion. Oropharynx class III Mallampati score, lungs clear, CV RRR, no murmurs, gallops, extremities with lower extremity edema, no clubbing, rashes, ecchymosis, petechiae. Evaluation: negative ANA, DS-DNA, ENA, ANCA, anti-GBM, anti-CCP Ab. Normal immunoglobulins, complements and positive lupus anticoagulant. Chemistries: elevated creatinine, WBC 13.1, Hemoglobin 10.5, platelets 89. BNP 659, normal urinalysis. PFTs: restriction and reduced DLCO. Cardiac echo: moderately dilated LV, LVEF 40%, normal right ventricular size and function. CT chest showed diffuse bilateral pulmonary ground glass opacities. DISCUSSION: Clinical course included empiric antibiotics, bronchoscopy, heart failure management, high-dose steroids, and cyclophosphamide initiation for diffuse alveolar hemorrhage. He had clinical improvement but required readmission with progressive pulmonary symptoms, acute renal failure, and an acute ischemic stroke despite adequate anticoagulation. This met criteria for Catastrophic Antiphospholipid Antibody Syndrome. He was treated with plasma exchange, steroids/cyclophosphamide and rituximab. CONCLUSIONS: This case represents the spectrum of disorders seen in antiphospholipid antibody syndrome. Antiphospholipid antibody syndrome can have a broad range of presentation in the lungs. DISCLOSURE: Nothing to declare. KEYWORD: ANTIPHOSPHOLIPID ANTIBODY SYNDROME