Case Report: An Unusual Case of Acute Lower Limb Ischemia as Precursor of the Asherson's Syndrome

A young lady presenting with acute limb ischemia secondary to systemic lupus erythematosus, antiphospholipid syndrome and infective endocarditis

We report a case of a 35 years old lady presenting with acute upper limb ischemia secondary to systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS) and infective endocarditis (IE). It is rare for SLE/APLS to present with acute limb ischemia (ALI) as the initial manifestation. The patient presented with high grade fever along with pain and numbness in her right upper limb. On examination her right upper limb was cold to touch and the peripheral pulses were not palpable. There was also an audible pansystolic murmur in the mitral area. CT Angiography confirmed a complete occlusion of the right axillary artery while echocardiogram revealed severe mitral regurgitation with large vegetations on the mitral valve leaflets, suggesting infective endocarditis. After the patient's clinical deterioration and considering the severity of the ischemic condition, additional investigations were conducted, which ultimately led to the diagnosis of SLE with APLS. Management included antibiotic therapy for IE and high dose of IV steroids and anticoagulants for SLE/APLS, to which she responded well. This case emphasizes the significance of conducting a comprehensive evaluation of all possible causes of acute limb ischemia, while considering the patient's medical history and physical examination findings.

Hallux Partial Necrosis Associated with Antiphospholipid Syndrome: The Importance of Early Accurate Diagnosis

This study highlights the importance of having a high clinical suspicion of hypercoagulopathy such as antiphospholipid syndrome (APS) in podiatric patients with normal foot pulses and normal standard coagulation tests. APS is an autoimmune disease that is characterized by inflammatory thrombosis in the arteries and veins and obstetric complications such as pregnancy loss. APS usually affects vessels of the lower extremities. We report herein the case of a 46-year-old woman with previous episodes of pre-eclampsia who suffered from partial ischemic necrosis of the hallux of the left foot. After several ischemic episodes of the hallux, with increased risk of toe amputation, the patient was finally diagnosed with APS and treated with specific anticoagulant medication. The patient's symptoms subsided, and toe amputation was prevented. Early accurate diagnosis and appropriate clinical management are critical to providing optimal outcomes and reducing the risk of amputation.