Clinical case of successful treatment of a patient with critical lower limb ischemia as a late onset of antiphospholipid syndrome
I.M. SADREEVA2, A.A. SADREEVA1, A.V. MAKSIMOV2, 3
1Republic Clinical Hospital, Kazan
2I.M. Sechenov First Moscow State Medical University, Moscow
3Kazan (Volga Region) Federal University, Kazan
Contact details:
Sadreeva I.M. — cardiologist of the Department of Vascular Surgery
Address: 138 Orenburgskiy trakt, Kazan, Russian Federation, 420064, tel.: +7-917-269-25-12, e-mail: Ealmira.s@gmail.ru
The antiphospholipid syndrome (APS) is characterized by non-inflammatory thrombotic vasculopathy with lesions of vessels of all types and localization. That is why clinical manifestations of APS are varied and patients turn to various physicians.
The article describes a clinical case of a critical lower limb ischemia in AP. A 62 y. o. female patient was under outpatient observation for two years with the clinic of intermittent claudication and a diagnosis of atherosclerosis of lower limb arteries. At the same time, a history of thrombosis of the splenic artery — atypical for atherosclerosis, laboratory phenomena: a false-positive Wassermann reaction and an elongation of the phospholipid-dependent test (APTT) indicated APS. The patient was admitted into Department of Vascular Surgery of the Republic Clinical Hospital with critical lower limb ischemia and a threat of amputation. Antiphospholipid antibodies were detected. Due to the therapy pathogenetic for APS, amputation of the lower extremity was avoided.
The presented clinical case shows that the APS may occur in people older than 60, and physicians of all specialties should be alert to this diagnosis.
Key words: clinical case, antiphospholipid syndrome, thrombosis, critical lower limb ischemia, false positive Wasserman reaction, APTT prolongation.
REFERENCES
- Reshetnyak T.M. Antiphospholipid syndrome: diagnosis and clinical manifestations (lecture). Nauchno-prakticheskaya revmatologiya, 2014, vol. 52, no. 1, pp. 56–71 (in Russ.). DOI: 10.14412/1995–4484–2014–56–71
- Cohen H., Cuadrado M.J., Erkan D., Duarte-Garcia A. et al. 16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends. Lupus, 2020, vol. 29 (12), pp. 1571–1593. DOI: 10.1177/0961203320950461
- Chayoua W., Kelchtermans H., Moore G.W. et al. Identification of high thrombotic risk triple-positive antiphospholipid syndrome patients is dependent on anti-cardiolipin and anti-β2glycoprotein I antibody detection assays. J Thromb Haemost, 2018, vol. 16 (10), pp. 2016–2023. DOI: 10.1111/jth.14261
- Trofimov E.A. Antiphospholipid syndrome: features of the course in pregnant women and principles of treatment. Vestnik NovGU, 2016, no. 6 (97) (in Russ.), available at: https://cyberleninka.ru/article/n/antifosfolipidnyy-sindrom-osobennosti-techeniya-u-beremennyh-i-printsipy-lecheniya
- Dabit J.Y., Valenzuela-Almada M.O., Vallejo-Ramos S. et al. Epidemiology of Antiphospholipid Syndrome in the General Population. Curr Rheumatol Rep, 2021, vol. 23, p. 85. DOI: 10.1007/s11926-021-01038-2
- Jara L.J., Medina G., Vera-Lastra O. Systemic antiphospholipid syndrome and atherosclerosis. Clin Rev Allergy Immunol, 2007, vol. 32 (2), pp. 172–177. DOI: 10.1007/s12016-007-0008-9. PMID: 17916989
- Rodríguez-Pintó I., Moitinho M., Santacreu I. et al. CAPS Registry Project Group (European Forum on Antiphospholipid Antibodies). Catastrophic antiphospholipid syndrome (CAPS): Descriptive analysis of 500 patients from the International CAPS Registry. Autoimmun Rev, 2016, vol. 15 (12), pp. 1120–1124. DOI: 10.1016/j.autrev.2016.09.010
- Bitsadze V.O., Khizroeva D.Kh., Idrisova L.E., Abramyan R.R., Andreeva M.D., Makatsariya A.D. Catastrophic antiphospholipid syndrome. Issues of pathogenesis. Akusherstvo, ginekologiya i reproduktsiya, 2015, no. 2, pp. 32–53 (in Russ.). DOI: 10.17749/2070-4968.2015.9.2.032-053