Complex Antiphospholipid Syndrome Successfully Controlled for 17 Years with Personalized Enoxaparin Therapy.

Area of Science:

• Internal Medicine
• Rheumatology
• Autoimmune Diseases

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder causing thrombosis and pregnancy complications.
• This case details a 56-year-old female with triple antibody-positive APS and multiple rare manifestations.

Purpose of the Study:

• To describe a complex case of Antiphospholipid Syndrome (APS).
• To highlight rare APS manifestations and their management.
• To emphasize personalized anticoagulation strategies in APS.

Main Methods:

• Case report of a 56-year-old female with APS.
• Detailed clinical follow-up including thrombotic and hemorrhagic events.
• Management with chronic enoxaparin, guided by anti-factor Xa activity.

Main Results:

• The patient experienced rare APS manifestations: purpuric lesions, adrenal insufficiency, acalculous cholecystitis, Budd-Chiari syndrome, and Addison's disease.
• She suffered severe thrombotic and hemorrhagic events, including splanchnic vein thrombosis and hemorrhagic shock.
• Long-term enoxaparin therapy, with dose adjusted by anti-factor Xa activity, resulted in 17 years of event-free stability.

Conclusions:

• Atypical APS presentations necessitate vigilance for unusual complications.
• Personalized anticoagulation, guided by anti-factor Xa activity, is crucial for managing APS.
• This case underscores the importance of tailored therapeutic strategies and close monitoring in APS patients.