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Bone marrow necrosis in antiphospholipid syndrome

S Paydas1, R Koçak, S Zorludemir

  • 1Department of Oncology, Cukurova University Faculty of Medicine, Balcali, Adana, Turkey.

Journal of Clinical Pathology
|March 1, 1997
PubMed
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Antiphospholipid syndrome (APS) can cause extensive bone marrow necrosis (BMN), a rare condition linked to poor outcomes. This case highlights APS as a potential, though unusual, cause of BMN.

Area of Science:

  • Hematology
  • Rheumatology
  • Pathology

Background:

  • Bone marrow necrosis (BMN) is a rare condition often associated with neoplastic disorders, infections, or sickle cell anemia.
  • Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent thrombotic events and/or pregnancy-related complications.

Observation:

  • A 27-year-old woman with a history of cerebrovascular accident presented with severe pancytopenia, fever, hypertension, hepatosplenomegaly, and vaginal bleeding.
  • Laboratory findings revealed a positive Coombs' test, prolonged coagulation times, positive anticardiolipin antibodies, and a positive anti-SM antibody test.
  • Bone marrow biopsy confirmed extensive necrosis, despite negative antinuclear and anti-DNA antibodies.

Findings:

  • The patient was diagnosed with antiphospholipid syndrome (APS) and extensive bone marrow necrosis (BMN).

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  • Treatment with steroids, transfusions, and plasma exchange provided partial clinical improvement but did not resolve the pancytopenia.
  • This case underscores the association between APS and BMN, expanding the known spectrum of APS complications.

    • Implications:

    • This case suggests that antiphospholipid syndrome should be considered in the differential diagnosis of unexplained bone marrow necrosis.
    • Further research is warranted to elucidate the mechanisms linking APS and BMN and to optimize treatment strategies.
    • Recognizing this association can lead to earlier diagnosis and potentially improved management for patients presenting with BMN.