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[Pulmonary thromboembolism in antiphospholipid syndrome]
F L Dumoulin1, W G Daniel, P Lichtlen
1Abteilung Immunologie und Transfusionsmedizin, Zentrums Innere Medizin und Dermatologie der Medizinischen Hochschule Hannover.
Deutsche Medizinische Wochenschrift (1946)
|June 18, 1993
Summary
This case study highlights a patient with a long history of thrombotic events and autoimmune markers, ultimately diagnosed with secondary antiphospholipid syndrome. Despite aggressive treatment, the patient succumbed to right heart failure.
Area of Science:
- Internal Medicine
- Rheumatology
- Hematology
Background:
- A 37-year-old woman presented with a 17-year history of systemic venous thromboses, recurrent pulmonary emboli, and multiple miscarriages.
- She had been symptomatic with pulmonary hypertension for seven years, with persistently low platelet counts.
Observation:
- Despite therapeutic anticoagulation with phenprocoumon and heparin, the patient experienced new pulmonary emboli and a significant drop in platelet count.
- Elevated anticardiolipin, antinuclear, and anti-ds-DNA antibodies, along with complement consumption, indicated secondary antiphospholipid syndrome, likely associated with lupus erythematodes.
Findings:
- Initial treatment with high-dose prednisolone, intravenous immunoglobulins, and intensive heparin therapy temporarily increased platelet count.
- Platelet counts decreased upon reduction of prednisolone, but recovered with the addition of azathioprine.
Implications:
- This case underscores the complexity of managing antiphospholipid syndrome, particularly when secondary to systemic lupus erythematosus.
- Aggressive immunosuppressive and anticoagulant therapy may be necessary, but outcomes can remain challenging, as evidenced by the patient's fatal outcome from right heart failure.