A case of antiphospholipid syndrome presenting cryptogenically as Budd-Chiari syndrome, then fulminantly as Libman-Sacks endocarditis
| Autor: | Hart A Goldhar, Paloma O’Meara, Lana A Castellucci |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Population Budd-Chiari Syndrome 030105 genetics & heredity Transesophageal echocardiogram Libman–Sacks endocarditis Thrombophilia Inferior vena cava Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Antiphospholipid syndrome Internal medicine medicine Humans Lupus Erythematosus Systemic Endocarditis cardiovascular diseases education education.field_of_study Unusual Presentation of More Common Disease/Injury medicine.diagnostic_test business.industry General Medicine Middle Aged Antiphospholipid Syndrome medicine.disease Stroke medicine.vein Endocarditis Non-Infective Budd–Chiari syndrome Cardiology Female business 030217 neurology & neurosurgery |
| Zdroj: | BMJ Case Rep |
| ISSN: | 1757-790X |
| DOI: | 10.1136/bcr-2018-227450 |
| Popis: | A 58 year-old left-handed woman was transferred to our hospital with an evolving left middle cerebral artery stroke, severe thrombocytopenia and elevated inflammatory markers. She had a history of chronic Budd-Chiari syndrome (BCS) 16 months prior, attributed to a calcified web in the inferior vena cava that was stented. No thrombophilia testing was performed at that time. The current presentation demonstrated dense right-sided facial and arm paresis and neglect. Erythrocyte sedimentation rate and C-reactive protein were elevated, an autoimmune workup was consistent with a new diagnosis of systemic lupus erythematosus and triple-positive antiphospholipid antibodies. A transesophageal echocardiogram demonstrated a vegetation consistent with Libman-Sacks endocarditis (LSE), thought to have embolised to the brain. The patient was treated acutely with steroids, intravenous immunoglobulin and clopidogrel. This case demonstrates an atypical constellation of the antiphospholipid syndrome, with a novel presentation of BCS and LSE, and reinforces the importance of hypercoagulability screening in this population. |
| Databáze: | OpenAIRE |
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