Tuberous sclerosis and primary antiphospholipid syndrome

Tuberous sclerosis complex (TSC) is a rare neurocutaneous disorder presenting with growth of hamartomas in various parts of the body. There have been few reported cases of TSC coexisting with hypercoagulable states from protein C and S deficiency and systemic lupus erythematosus, but to the best of our knowledge, this is the first documented case of TSC occurring with primary antiphospholipid syndrome. We report the case of an adolescent female with ash-leaf spots, shagreen patches, cortical tubers and seizures presenting with acute unilateral vision loss from ophthalmic artery thrombosis. Work-up was positive for lupus anticoagulant, and genetic testing confirmed a mutation in the TSC1 gene. She was maintained on aspirin, warfarin and anti-seizure medications. Experimental models suggest possible pathways linking TSC1 deficiency with thrombosis, although this association remains unclear in humans. Podoplanin has been implicated as a candidate gene in both TSC-related epilepsy and thrombosis, potentially linking these two conditions.