Setting Of Antiphospholipid Syndrome Research Articles

Unilateral Adrenal Infarction in Pregnancy: A Case Report

Adrenal infarction is usually associated with bilateral adrenal hemorrhage in the setting of antiphospholipid syndrome or hemodynamic variation. Few cases of unilateral non-hemorrhagic adrenal infarction have been described in the literature. Here, we report a case occurring during pregnancy. A 27-year-old woman was infected by coronavirus four months ago and presented at 35 weeks of gestation with sudden-onset right abdominal pain without contractions. Unilateral adrenal infarction was diagnosed following computed tomography. It showed an enlarged right adrenal, without hyperenhancement. The patient’s adrenal hormonal function was normal. Accurate diagnosis of non-hemorrhagic adrenal infarction remains difficult as its clinical presentation is not specific. It can only be performed with adrenal imaging. Magnetic resonance imaging shows diffuse enlargement of one or both adrenals and edema on T2-weighted images. Anticoagulation therapy may be discussed. Patients should be evaluated between 3 and 6months after the event to assess adrenal size and function. In summary, non-hemorrhagic adrenal infarction during pregnancy is probably underdiagnosed and obstetricians should be aware of this diagnostic difficulty.

Nécrose hémorragique bilatérale des surrénales sous apixaban : penser au syndrome des antiphospholipides ?

IntroductionAdrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. Case reportWe present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. ConclusionTo our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.

MANAGEMENT OF ST ELEVATION MYOCARDIAL INFARCTION IN PATIENT WITH ANTIPHOSPHOLIPID SYNDROME AND IDIOPATHIC THROMBOCYTOPENIC PURPURA

No clear guidelines exist for appropriate dual antiplatelet therapy (DAPT) and anticoagulation (AC) after percutaneous coronary intervention for patients with ST elevation myocardial ischemia (STEMI) in setting of antiphospholipid syndrome (APS) and Idiopathic Thrombocytopenic Purpura (ITP). 29-

Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature

Acute superior mesenteric vein thrombosis is an uncommon but life threatening disease condition. In the setting of antiphospholipid syndrome, it is rare. This is a case of a 49 year old male who presented with a 2 day history of nausea, vomiting and abdominal pain. He had a previous history of deep vein thrombosis and pulmonary embolism about a year ago. Triple phase computed tomography confirmed superior mesenteric vein thrombosis. Lupus anticoagulant antibody was positive. He was initiated on heparin and then transitioned to warfarin. Given the finding of primary antiphospholipid syndrome, he is currently on lifelong anticoagulant therapy. Surgical resection, site directed thrombolysis and thrombectomy are other options of treatment for acute superior mesenteric vein thrombosis. With the diagnosis of acute superior mesenteric venous thrombosis, with or without any identifiable triggering factor, a search for hypercoagulable state is indicated. This will help determine the duration of anticoagulation therapy and prevent recurrent thrombosis. Acute Superior Mesenteric Vein Thrombosis in a Patient with Primary Antiphospholipid Syndrome: A Case Report and Brief Review of the Literature.

Case Report: A case of antiphospholipid-antibody-associated reactive angioendotheliomatosis and panniculitis

Introduction:Reactive angioendotheliomatosis (RAE) is a benign vascular disorder with a varied clinical presentation that has been associated with a wide range of systemic illnesses. It is characterized histologically by intravascular and extravascular hyperplasia of endothelial cells and pericytes, and this entity only affects the skin. We present the rare case of a woman with both RAE and panniculitis associated with anticardiolipin antibodies in the setting of antiphospholipid syndrome (APLS).Case description:A female in her forties presented for a second opinion of lumps in her skin. The first lump was noted on her right thigh four years prior to presentation, and biopsy demonstrated longstanding septal and lobular panniculitis. Studies that followed this finding revealed a diagnosis of APLS, and the patient had been placed on 400 mg per day of hydroxychloroquine and a daily low-dose of aspirin. She presented with a new subcutaneous plaque on the left lower back, and biopsy of this lesion was suggestive of RAE. She had no history of significant thrombotic events and had never been treated with an anticoagulant. Work-up was negative for other connective tissue diseases that are known for producing subcutaneous nodular lesions.Discussion:RAE is very rare, with less than 50 cases reported in total; five of these in association with APLS. In the context of APLS, RAE is likely a result of the procoagulant state induced by the presence of antiphospholipid antibodies. This case of both RAE and panniculitis associated with anticardiolipin antibodies in the setting of APLS describes rare manifestations of APLS as isolated incidents in a relatively healthy patient.

Basilar Artery Thrombosis in the Setting of Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder characterized by arterial or venous thrombosis, recurrent first-trimester pregnancy loss, and multiple additional clinical manifestations. We describe a man with severe atherosclerotic basilar artery stenosis and superimposed in situ thrombus who was found to have antiphospholipid syndrome.

Thrombocytopenia and thrombosis: a double-edged sword

Severe thrombocytopenia with bleeding associated with a life-threatening thrombotic manifestation in the setting of antiphospholipid syndrome is a major diagnostic and therapeutic challenge for the clinician. Hemorrhage is a less common complication than thrombosis in patients with APS, although severe thrombocytopenia can sometimes result in bleeding. There are no evidence-based guidelines regarding the management of a patient with severe thrombocytopenia associated with a major thrombotic manifestation. In this case report, we review the literature reporting the difficulties in management of such patient.