scholarly journals Coronavirus-disease-2019-induced antiphospholipid-like syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Fatemeh Bahramnezhad ◽  
Banafsheh Ghorbani ◽  
Meysam Ghaedrahamt ◽  
Hamidreza Jamaati
Keyword(s):  
Differential Diagnosis ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Anticardiolipin Antibody ◽  
High Rate ◽  
Medical Community ◽  
Polymerase Chain Reaction Test ◽  
Left Hand

Abstract Background This paper describes a case of antiphospholipid syndrome-like condition caused by coronavirus disease 2019. The medical community still faces many diagnostic and therapeutic challenges vis-à-vis coronavirus disease 2019. Ultimately, coronavirus disease 2019 is diagnosed on the basis of laboratory and radiological findings. Considering the high rate of mortality due to coagulation abnormalities and thrombosis among coronavirus disease 2019 patients, it is important to pay attention to the differential diagnoses of coronavirus disease 2019 and other diseases following thrombotic events. Case description The patient was a 56-year-old Iranian man who underwent coronary artery bypass graft surgery and mitral valve repair. During hospitalization, the patient showed an elevated level of anticardiolipin antibody (immunoglobulin G isotype), antiphospholipid antibodies, and thrombosis in the brachial artery of the left hand, based on which a differential diagnosis of antiphospholipid syndrome was made. However, ultimately, the coronavirus disease 2019 polymerase chain reaction test and computed tomography scan of the lungs showed that the patient had coronavirus disease 2019. Conclusion According to the few studies performed on coronavirus disease 2019 patients, elevated levels of the isotypes of antiphospholipid antibodies in coronavirus disease 2019 patients create conditions similar to antiphospholipid syndrome, which, in the absence of reliable coronavirus disease 2019 testing, can lead to misdiagnosis and consequently delayed or improper treatment. Therefore, to provide timely and appropriate treatment, it is important to pay attention to differential diagnosis.

scholarly journals Multiple Recurrent Stent Thrombosis in a Patient with Coexisting Clopidogrel Resistance and Increased Anticardiolipin Antibodies: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Erik H. Middlebrooks ◽  
Mukta Panda
Keyword(s):  
Stent Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Anticardiolipin Antibodies ◽  
Drug Eluting Stents ◽  
Multiple Drug ◽  
Clopidogrel Resistance ◽  
Antibody Titers ◽  
Drug Eluting

The antiphospholipid syndrome (APS) is a common cause of both arterial and venous thrombosis. While studies exist demonstrating the role of APS in coronary artery bypass graft failure, its role in stent thrombosis is less clearly documented. Also, a literature search of PubMed did not reveal any articles regarding the coexistence of clopidogrel resistance and APS despite increasing awareness of resistance to clopidogrel treatment. We present a case of a 59-year-old male having recurrent myocardial infarction after subacute restenosis of multiple drug-eluting stents despite anticoagulant therapy. The patient had in-stent thrombosis of seven drug-eluting stents in a course of eight days. He was subsequently found to have mild elevation of IgG anticardiolipin (aCL) antibody titers and resistance to clopidogrel. Long-term anticoagulation with a combination of low-molecular-weight heparin, clopidogrel, and aspirin has been effective. While the patient's aCL titer level was not elevated above the level required by the current diagnostic criteria for APS, we believe that this patient suffers from the antiphospholipid syndrome. We will discuss some of the controversies surrounding the diagnosis of APS as well as appropriate treatment and recognition of the coexistence of APS and clopidogrel resistance in patients with stent thrombosis.

scholarly journals P030 Antiphospholipid syndrome and giant cell arteritis: a coincidence or connection?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Luke Sammut ◽  
Ei Phyu Htut
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Anticardiolipin Antibody ◽  
Functional Mobility ◽  
Large Vessel ◽  
Left Vertebral Artery ◽  
Mri Brain ◽  
History Of

Abstract Background/Aims  Antiphospholipid syndrome (APS) is a multisystem autoimmune disorder, which can be primary or associated with other conditions including systemic lupus erythematosus. Several studies have reported antiphospholipid antibodies, in patients with different vasculitides but little is known about the occurrence of APS and giant cell arteritis (GCA). We report a case of a patient diagnosed with concomitant extracranial GCA and APS. Methods  A 74-year-old lady presented to the Emergency department following a fall at home. On further questioning, she reported a rapid history of weight loss (4kg in the previous 4 weeks) but no classical features of giant cell arteritis. Her temporal arteries were pulsatile bilaterally, not tender or thickened. Cranial nerve examination including fundoscopy was normal. Her gait was apraxic, with short stride length and veering to the right with a narrow base. The rest of the examination was unremarkable. Results  Laboratory investigations showed an elevated CRP 98mg/L with a normal ESR 23mm/h, ferritin 380 ng/ml, negative ANCA and ANA, with an unremarkable myeloma screen. Microbiology investigations demonstrated negative serial blood cultures, hepatitis screen, and quantiferon. She subsequently underwent intracranial imaging [CT and MRI brain with Gadolinium] which did not demonstrate acute pathology. A PET CT confirmed features in keeping with a large vessel vasculitis without aneurysmal formation. She was treated with pulsed IV methylprednisolone 500mg for 3 consecutive days and started on 60mg oral prednisolone daily. Two days after starting this treatment she developed acute onset double vision: ophthalmologic examination revealed new onset right internuclear ophthalmolplegia (INO). A subsequent CT head angiogram showed non critical stenoses in aorta at origins of great vessels, left vertebral artery, and carotids. Interval MRI brain showed a new infarct in pons corresponding with her INO. Bloods revealed triple positive anti-phospholipid antibodies - [IgG anticardiolipin antibody 102 GPL (0-13), anti-β2 glycoprotein I antibodies 59.8 U/ml (0-18), Lupus anticoagulant detected]. She was commenced on warfarin [target INR 2.5] and aspirin. Due to mental health history and large vessel manifestations, she was started on IV Tocilizumab 8mg/kg and her prednisolone dose was reduced to 40mg when her CRP normalised. Following hospitalisation, she had persistent visual disturbance with ongoing poor spatial co-ordination. Although she remained ataxic, her functional mobility improved. She was transferred to a local stroke unit and was discharged home. Conclusion  In summary, this is a case of GCA and APS, treated with prednisolone, aspirin, warfarin and tocilizumab. There is increasing evidence describing the presence of antiphospholipid antibodies in patients with vasculitis. However, the role of these antibodies in GCA and the clinical significance remains unclear. This case reports highlights the need for physicians to consider APS in patients who have a history of GCA and subsequently develop arterial or venous embolic events. Disclosure  L. Sammut: None. E. Htut: None.

scholarly journals Ascariasis and Cardiac Surgery: A Case Report

2021 ◽  
Author(s):  
Ajmer Singh ◽  
Ravi K Mahavar ◽  
Yatin Mehta
Keyword(s):  
Differential Diagnosis ◽  
Cardiac Surgery ◽  
Case Report ◽  
Elective Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Parasitic Infection ◽  
Artery Bypass Graft ◽  
Lung Collapse ◽  
Helminthic Infection

AbstractAscariasis is a common helminthic infection, particularly in the tropical countries. We describe a case of eosinophilia who underwent coronary artery bypass graft (CABG) surgery. Postoperatively, he was found to have ascaris lumbricoides in the oral cavity. Timely detection and removal of the worm prevented the possible complications such as airway obstruction, bronchospasm, lung collapse, or intestinal obstruction. The case emphasizes the importance of considering parasitic infection as a differential diagnosis in patients presenting with eosinophilia for elective surgery.

European registry of babies born to mothers with antiphospholipid syndrome: a result update

Lupus ◽  
2009 ◽  
Vol 18 (10) ◽  
pp. 900-904 ◽  
Author(s):  
M-C Boffa ◽  
E Lachassinne ◽  
C Boinot ◽  
S De Carolis ◽  
P Rovere-Querini ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Antiphospholipid Syndrome ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Antiphospholipid Antibodies ◽  
Anticardiolipin Antibodies ◽  
High Rate ◽  
Neuropsychological Development ◽  
Premature Babies ◽  
European Registry

The registry is a prospective, European, multicentric, longitudinal study, which follows a cohort of children born to mothers with antiphospholipid syndrome (APS). It was started in 2003. In this report, we update the results obtained from the study of 110 mothers and 112 children (two twin births). Eighty per cent of the mothers ( n = 86) had primary APS. Purely obstetrical, thrombotic and mixed (obstetrical and thrombotic) APS represent 65.5 %, 21.8 % and 12.7 % of the whole cohort respectively. Isolated antiphospholipid antibodies and isolated anticardiolipin antibodies positivity were present in 50 of 109 (46%) and in 34 of 109 (31%) of the pregnant women, respectively. In the babies, in spite of a high rate of prematurity (14.3%) with four (3.6%) of the premature babies born before 33 weeks of gestation and an increased number of newborns small for gestational age (17%), the large majority of the neonates were healthy. Thirty-one infants are now older than 24 months. Among them, three displayed behavioural abnormalities before 3 years of age. After completing data, there will be the possibility to evaluate the newborn status in relation to the mothers’ diseases, treatments and antibodies and to follow the neuropsychological development and immunological evolution of the babies during the next 5 years.

Spinal cord infarction associated with primary antiphospholipid syndrome in a young child

1993 ◽  
Vol 79 (3) ◽  
pp. 446-450 ◽  
Author(s):  
Mitsuhiro Hasegawa ◽  
Junkoh Yamashita ◽  
Tetsumori Yamashima ◽  
Kiyonobu Ikeda ◽  
Yoshie Fujishima ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Spinal Cord Ischemia ◽  
Anticardiolipin Antibody ◽  
Acute Stage ◽  
Spinal Cord Infarction ◽  
Primary Antiphospholipid Syndrome ◽  
Content Type

✓ Antiphospholipid antibodies have been reported to occur in ischemic stroke patients, but there have been no previous reports linking these antibodies to spinal cord infarction. A case of spinal cord infarction associated with primary antiphospholipid syndrome in a 6-year-old boy is reported. Magnetic resonance imaging clearly demonstrated marked swelling of the thoracolumbar spinal cord with gadolinium-diethylenetriamine pentaacetic acid enhancement at an acute stage, followed later by cord atrophy. Serological study disclosed positive lupus anticoagulant and immunoglobulin G anticardiolipin antibody. It is suggested that the role of antiphospholipid antibodies as an etiological factor for spinal cord ischemia should be recognized among causes that might have been categorized as either spontaneous spinal cord infarction or myelitis.

COVID-19 and antiphospholipid antibodies: A position statement and management guidance from AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION)

Lupus ◽  
2021 ◽  
pp. 096120332110625
Author(s):  
Xin Wang ◽  
Elena Gkrouzman ◽  
Danieli Castro Oliveira Andrade ◽  
Laura Andreoli ◽  
Medha Barbhaiya ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Neutrophil Extracellular Traps ◽  
Position Statement ◽  
Endothelial Damage ◽  
High Rate ◽  
Research Network ◽  
Extracellular Traps ◽  
Management Guidance

Coronavirus disease 2019 (COVID-19) is associated with a high rate of thrombosis. Prolonged activated partial thromboplastin times (aPTT) and antiphospholipid antibodies (aPL) are reported in COVID-19 patients. The majority of publications have not reported whether patients develop clinically relevant persistent aPL, and the clinical significance of new aPL-positivity in COVID-19 is currently unknown. However, the reports of aPL-positivity in COVID-19 raised the question whether common mechanisms exist in the pathogenesis of COVID-19 and antiphospholipid syndrome (APS). In both conditions, thrombotic microangiopathy resulting in microvascular injury and thrombosis is hypothesized to occur through multiple pathways, including endothelial damage, complement activation, and release of neutrophil extracellular traps (NETosis). APS-ACTION, an international APS research network, created a COVID-19 working group that reviewed common mechanisms, positive aPL tests in COVID-19 patients, and implications of COVID-19 infection for patients with known aPL positivity or APS, with the goals of proposing guidance for clinical management and monitoring of aPL-positive COVID-19 patients. This guidance also serves as a call and focus for clinical and basic scientific research.

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