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Cervera R, Espinosa G. Unusual manifestations of the antiphospholipid syndrome. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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2
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Lim E, Wicks I, Roberts LJ. Intracardiac thrombosis complicating antiphospholipid antibody syndrome. Intern Med J 2004; 34:135-7. [PMID: 15030465 DOI: 10.1111/j.1444-0903.2004.00558.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Asherson RA, Cervera R. Unusual manifestations of the antiphospholipid syndrome. Clin Rev Allergy Immunol 2003. [PMID: 12794262 DOI: 10.1385/criai] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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Affiliation(s)
- Ronald A Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine, Cape Town, South Africa
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Abstract
The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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Affiliation(s)
- Ronald A. Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine, Cape Town, South Africa
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
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Mottram PM, Gelman JS. Mitral valve thrombus mimicking a primary tumor in the antiphospholipid syndrome. J Am Soc Echocardiogr 2002; 15:746-8. [PMID: 12094176 DOI: 10.1067/mje.2002.118914] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac valvular abnormalities detected by echocardiography are relatively common in patients with the primary antiphospholipid syndrome. Valvular thickening with small vegetations are typical, but reports of lesion histology are rare. We report the case of a 50-year-old man presenting with thromboembolic phenomena who had a large (>2 cm), mobile, pedunculated, mass attached to the mitral valve that had the echocardiographic appearance of a primary valve tumor. Following surgical removal, histopathologic examination demonstrated pure fibrin thrombus and serological testing confirmed the antiphospholipid syndrome. This case highlights an unusual echocardiographic appearance of intracardiac thrombus in this syndrome.
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Affiliation(s)
- Philip M Mottram
- Centre for Heart and Chest Research, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
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Ebato M, Kitai H, Kumakura H, Nakamura Y, Shimizu N, Takeyama Y. Thrombus on the tricuspid valve in a patient with primary antiphospholipid syndrome after implantation of an inferior vena cave filter. Circ J 2002; 66:425-7. [PMID: 11954963 DOI: 10.1253/circj.66.425] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 62-year-old woman with a history of pulmonary embolism and primary antiphospholipid syndrome (PAPS) with positivity for lupus anticoagulant was admitted to hospital with shortness of breath. A filter had been implanted in her inferior vena cava (IVC) 5 years previously. Emergency echocardiography revealed a lobulated, mobile echogenic mass on the tricuspid valve, and on pulmonary perfusion scintigraphy several apparently new defects were noted. Fibrinolytic therapy improved her symptoms and the pulmonary perfusion, then intravenous heparinization was continued for a further week. Repeat echocardiography performed on the 7th day of the admission showed complete disappearance of the mass, which was retrospectively diagnosed as a thrombus based on its resolution with fibrinolytic and anticoagulant therapies.
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Affiliation(s)
- Mio Ebato
- Division of Clinicopathology, Showa University Fujigaoka Hospital, Yokohama, Japan
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Schmidt R, Scheuermann EH, Viertel A, Geiger H, Scharrer I. [Antiphospholipid antibody syndrome]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1999; 94:93-100. [PMID: 10194954 PMCID: PMC7095803 DOI: 10.1007/bf03044707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/1997] [Accepted: 07/09/1998] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antiphospholipid antibodies comprise a family of auto-antibodies mainly characterized by the presence of the lupus anticoagulant (LA) and anticardiolipin antibodies (ACA). CLINICAL APPEARANCE The antiphospholipid antibody syndrome is defined by the appearance of frequent thromboses, repeated fetal losses and thrombocytopenia. Other clinical manifestations associated with APA include migraine, chorea, hemolytic anemia, heart valve disease, Budd-Chiari syndrome, perpetual pancreatitic episodes, intestinal infarctions, malignant hypertension, livedo reticularis, pre-eclampsia, fetal growth retardation or catastrophic antiphospholipid syndrome. LA and ACA occur in a variety of clinical conditions (secondary antiphospholipid antibody syndrome, SAPS), including other autoimmune disorders, infectious diseases, neoplastic disorders, in association with the use of certain drugs or in otherwise healthy individuals (primary antiphospholipid antibody syndrome, PAPS). TREATMENT Patients with thrombosis associated with APA should receive long-term anticoagulation therapy, whereas treatment of asymptomatic patients seems to be not indicated, because only approximately 10% of patients with APA may develop thrombotic complications. In patients with PAPS there is no evidence that the prophylactic administration of immunosuppressive drugs will prevent thromboembolic events.
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Affiliation(s)
- R Schmidt
- Medizinische Klinik IV, Johann-Wolfgang-Goethe-Universität, Frankfurt/M
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Harmouche H, Tazi Mezalek Z, Adnaoui M, Aouni M, Mohattane A, Maaouni A, Berbich A. [Association of pulmonary artery aneurysm, right heart thromboses and antiphospholipid antibodies in Behcet's disease]. Rev Med Interne 1998; 19:512-5. [PMID: 9775202 DOI: 10.1016/s0248-8663(99)80009-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiac thromboses are unusual in the course of Behçet's disease and are frequently associated with endomyocardial fibrosis of the right heart. Vascular pulmonary involvement with either pulmonary aneurysm or parenchyma alterations is also often observed. However, pathogenesis of thromboses occurring in the course of Behçet's disease is still unclear. CASE REPORT The authors report the case of a 28-year-old man who presented with Behçet's disease accompanied by pulmonary aneurysm, multiple thrombi of the right heart and antiphospholipid antibodies. CONCLUSION The choice of therapeutical strategies for curative treatment of this association as well as the interpretation of the role of antiphospholipid antibodies in this polyvascular disease raises questions.
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Affiliation(s)
- H Harmouche
- Service de médecine interne A, Hôpital Ibn Sina, Rabat, Maroc
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Kerr JE, Poe R, Kramer Z. Antiphospholipid antibody syndrome presenting as a refractory noninflammatory pulmonary vasculopathy. Chest 1997; 112:1707-10. [PMID: 9404782 DOI: 10.1378/chest.112.6.1707] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The clinical manifestations of antiphospholipid antibody syndrome (APLAS) are protean. Pulmonary manifestations are often thromboembolic in origin; ARDS and pulmonary hypertension have been reported as features of a widespread vasculopathy associated with systemic lupus or Sjögren's syndrome. This is the report of a woman with primary APLAS who died of a noninflammatory pulmonary vasculopathy. The case is unusual in its pulmonary manifestations, its initial response to corticosteroids and antithrombotic medications, its failure to stabilize with high-intensity warfarin sodium and aspirin treatment, and finally its fulminant progression despite multiple interventions.
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Affiliation(s)
- J E Kerr
- Department of Medicine, University of Rochester School of Medicine, Highland Hospital, NY, USA
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Plein D, Van Camp G, Efira A, Brunet A, Vandenbossche JL. Intracardiac thrombi associated with antiphospholipid antibodies. J Am Soc Echocardiogr 1996; 9:891-3. [PMID: 8943454 DOI: 10.1016/s0894-7317(96)90486-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two cases of intracardiac thrombi associated with antiphospholipid antibodies are presented, one in the right atrium and the other in the left ventricle, the latter occurring in the presence of normal left ventricular function. In each, the diagnosis was made by transthoracic echocardiography. Both patients had contraindications to thrombolytic therapy and underwent successful surgical thrombectomy. We suggest that serial transthoracic echocardiography may be warranted in the follow-up of patients with primary hypercoagulable states.
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Affiliation(s)
- D Plein
- Department of Cardiology, St Pierre University Hospital, Bruxelles, Belgium
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Hojnik M, George J, Ziporen L, Shoenfeld Y. Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation 1996; 93:1579-87. [PMID: 8608627 DOI: 10.1161/01.cir.93.8.1579] [Citation(s) in RCA: 246] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The antiphospholipid syndrome (APS) is defined by the presence of anti-phospholipid antibodies (aPLs) and venous or arterial thrombosis, recurrent pregnancy loss, or thrombocytopenia. The syndrome can be either primary or secondary to an underlying condition, most commonly systemic lupus erythematosus (SLE). Echocardiographic studies have disclosed heart valve abnormalities in about a third of patients with primary APS. SLE patients with aPLs have a higher prevalence of valvular involvement than those without these antibodies. Valvular lesions associated with aPLs occur as valve masses (nonbacterial vegetations) or thickening. These two morphological alterations can be combined and are thought to reflect the same pathological process. Both can be associated with valve dysfunction, although such association is much more common with the latter alteration. The predominant functional abnormality is regurgitation; stenosis is rare. The mitral valve is mainly affected, followed by the aortic valve. Valvular involvement usually does not cause clinical valvular disease. The presence of aPLs seems to further increase the risk for thromboembolic complications, mainly cerebrovascular, posed by valve lesions. Superadded bacterial endocarditis is rare but may be difficult to distinguish from pseudoinfective endocarditis. The current therapeutic guidelines are those for APS in general. Secondary antithrombotic prevention with long-term, high-intensity oral anticoagulation is advised. The efficacy of aspirin, either alone or in combination, is yet to be assessed. Corticosteroids are not beneficial and may even facilitate valve damage. Immunosuppressive agents should only be used for the treatment of an underlying condition. Current data suggest a role for aPLs in the pathogenesis of valvular lesions. aPLs may promote the formation of valve thrombi. These antibodies may also act by another mechanism, as indicated by the finding of subendothelial deposits of immunoglobulins, including anticardiolipin antibodies, and of colocalized complement components in deformed valves from patients with APS.
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Affiliation(s)
- M Hojnik
- Department of Medicine "B", Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
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Day SM, Rosenzweig BP, Kronzon I. Transesophageal echocardiographic diagnosis of right atrial thrombi associated with the antiphospholipid syndrome. J Am Soc Echocardiogr 1995; 8:937-40. [PMID: 8611297 DOI: 10.1016/s0894-7317(05)80021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thromboembolic disorders are a hallmark of the antiphospholipid antibody syndrome. We describe a patient with IgM antiphospholipid antibodies associated with pulmonary emboli and in situ thrombosis within an otherwise normal right atrium. Echocardiography, particularly the transesophageal study, proved invaluable in providing a diagnosis and guiding our patient's evaluation and treatment.
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Affiliation(s)
- S M Day
- Department of Medicine, New York University School of Medicine, NY, USA
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Abstract
A 41 year old woman with the antiphospholipid antibody syndrome presented with a cerebral embolus. This was caused by a mobile left ventricular thrombus that later resolved. There was an additional old left ventricular thrombus. Left ventricular thrombi such as these have not been previously described in this syndrome, and may have been under diagnosed.
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Affiliation(s)
- D Bruce
- Department of Cardiology, Royal United Hospital, Bath
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Affiliation(s)
- G A Nickele
- Department of Medicine, Medical College of Wisconsin, Milwaukee 53226
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Denie C, Lefebvre C, Dion R, Coche E. [Thrombus of the right atrium simulating myxoma in primary antiphospholipid syndrome]. Rev Med Interne 1994; 15:409-11. [PMID: 8059174 DOI: 10.1016/s0248-8663(05)81457-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Various thrombo-embolic complications have been related to the antiphospholipid syndrome. The authors report the case of a patient with a primary antiphospholipid syndrome associated with a right auricular mass highly suggesting a myxoma by both echocardiography and nuclear magnetic resonance imaging. Meanwhile, the histological examination of the operative specimen showed a well organized and calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of the antiphospholipid syndrome. The preoperative investigations can't differentiate such a thrombus with a myxoma and the diagnosis is usually made postoperatively.
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Affiliation(s)
- C Denie
- Service de médecine interne, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
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