Sekundarni fosfolipidni sindrom otkriven kod pacijenta sa pneumonijom - prikaz slučaja

Biljana Lazović,Dženana Detanac,Vladimir Zugić,Sanja Šarac,Mirjana Zlatković-Svenda,Džemail Detanac,Ivana Blažić,Jelena Kovač,Rade Milić

doi:10.24125/sanamed.v14i3.365

Abstract

Introduction: Secondary antiphospholipid syndrome (SAPS) is APS that occurs in the context of another medical condition. Although antiphospholipid antibodies (aPL) can occur in patients with viral, bacterial, or protozoal infections, they are rarely associated with thrombosis. Aim: To present an uncommon case of pneumonia and pleural effusion complicated with pulmonary thromboembolism in a patient with systemic lupus erythematosus (SLE), due to non-diagnosed secondary antiphospholipid syndrome. Case report: A 28 years old woman, never pregnant, with a family history of systemic lupus erythematosus, has been suffering from SLE from the age of 18. She had only articular and skin manifestations, without internal organ involvement. She has been taking Methotrexate (10 mg weekly) and Prednisone (5 mg daily) in the previous 10 years. She was presented at the Emergency department with the radiological finding of pleuropneumonia followed by temperature up to 39C, shortness of breath, cough, fatigue, and weakness. Results: She was treated initially with three antibiotics and thoracocentesis. She developed pulmonary thrombosis without deep venous thrombosis. Laboratory findings were: ESR = 37 mm/h, CRP = 2+, ANA = 1/80 peripheral, RF negative, anti-dsDNA = 147 (positive > 40), anti-Sm negative, anticardiolipin IgG antibody 158 GPL (up to 12), anticardiolipin IgM antibody 5.5 MPL (up to 10), anti-beta2-glycoprotein IgG and IgM were negative and lupus anti-coagulant was 88" (18"-55"). The patient underwent Heparin and Warfarin treatment, by checking INR to be in a 2.6 to 3.5 range. Prednisolone and Hydroxychloroquine were also started. Conclusion: All patients suspected with SLE should be evaluated for antiphospholipid antibodies (APL). However, APS diagnosis requires both clinical and laboratory features.

Highlights

Secondary antiphospholipid syndrome (SAPS) is Antiphospholipid syndrome (APS) that occurs in the context of another medical condition
All patients suspected with systemic lupus erythematosus (SLE) should be evaluated for antiphospholipid antibodies (APL)
Antiphospholipid syndrome (APS)or Hughes Syndrome is an autoimmune disordercaused by the blood clots forming increased risk accompanied by one of antiphospholipid antibodies (APL): anticardiolipin antibodies, anti-beta2-glycoprotein (GP1) antibodies and/or lupus anticoagulant (LA), registered in two or more occasions 12 weeks apart, resulting inarterial/venous thrombosis and/or fetal loss [1, 2]

Summary

Introduction

Secondary antiphospholipid syndrome (SAPS) is APS that occurs in the context of another medical condition. She had only articular and skin manifestations, without internal organ involvement She has not been regularly followed up, and her last evaluation at the Rheumatology Clinic was one year ago.She has been taking Methotrexate (10 mg weekly) and Prednisone (5 mg daily) in the previous 10 years. The patient was presented atthe Emergency department with high temperature up to 39C, shortness of breath, cough, fatigue, and weakness. Auscultation has revealed decreased breath sounds, absent in the basal parts of the left lung. Her blood pressure was 120/80 mmHg and heart rate 80/bpm. The patient was diagnosed with antiphospholipid syndrome, secondary to systemic lupus erythematosus.

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