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Dolor lumbar como una manifestación del síndrome antifosfolípido

Anjum Siddiqui¹, Pradeep Panday¹, Parag Vijayvergia¹

¹Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India.

BMJ case reports

|September 3, 2025

Resumen

El síndrome antifosfolípido (SAF) puede causar infartos óseos (necrosis vascular). Este caso destaca a una mujer joven con LES y APS secundario que desarrolló múltiples infartos óseos, enfatizando la necesidad de un diagnóstico y tratamiento rápidos.

Área de la Ciencia:

Reumatología
Medicina vascular
Enfermedades óseas

Sus antecedentes:

El síndrome antifosfolípido (APS) es un trastorno protrombótico asociado con trombosis arterial, venosa o microvascular y morbilidad durante el embarazo.
La necrosis vascular (AVN), o infarto óseo, afecta hasta al 2,9% de los pacientes con SPA, con múltiples sitios reportados en el 3-10% de los pacientes con uso de corticosteroides, LES o estados hipercoagulables.
Los sitios comúnmente afectados incluyen la cabeza femoral, las rodillas, los hombros y los tobillos, mientras que la afectación de las costillas o las vértebras es rara.

Objetivo del estudio:

Para presentar un caso de una mujer joven con lupus eritematoso sistémico (SLE) y APS secundario que desarrolló múltiples infartos óseos.
Discutir el mecanismo potencial de la trombosis de los vasos óseos en el desarrollo de la AVN en el contexto de la SPA.
Destacar la importancia del diagnóstico y tratamiento precoz de la NAV en pacientes con SPA y LES.

Principales métodos:

Informe de caso de una mujer joven que presenta dolor agudo de espalda, hipertensión y pérdida de embarazo recurrente.
El diagnóstico incluyó un escáner óseo trifásico Tc 99 que reveló infartos óseos.
El paciente fue diagnosticado con LES con SPA secundario e iniciado en inmunosupresión y anticoagulación.

Principales resultados:

La paciente presentó un inicio agudo de dolor de espalda, hipertensión acelerada y pérdida de embarazo recurrente.
Durante un mes, desarrolló dolor óseo en múltiples sitios, incluyendo el radio distal, la tibia bilateral y la columna vertebral T11-L3.
La exploración ósea confirmó infartos óseos, lo que condujo a un diagnóstico de LES con SPA secundario.

Conclusiones:

La trombosis de los vasos esqueléticos es un mecanismo potencial para la NAV en el SPA.
El reconocimiento temprano y el tratamiento con inmunosupresión y anticoagulación son cruciales para el tratamiento de la NAV en pacientes con LES y SPA secundario.
Este caso subraya las diversas manifestaciones de la SPA y su asociación con los infartos óseos.

Palabras clave:

Enfermedad del tejido conectivo Hipertensión El dolor Proteínas de la urea El lupus eritematoso sistémico

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