Case history
Case history #1
A 35-year-old woman has a history of 3 consecutive pregnancy losses before 12 weeks of pregnancy. She had no other known complications during the pregnancies. Further testing reveals a lupus anticoagulant, which is still present on repeat testing 12 weeks later. Physical exam is normal.
Case history #2
A 42-year-old man is referred because of central retinal vein thrombosis. Medical history is uneventful; in particular, he has no known risk factors for venous or arterial thromboembolic disease. Screening for antiphospholipid antibodies reveals moderately elevated anticardiolipin antibody levels on 2 occasions, 12 weeks apart.
Other presentations
Any vessel in the body can be affected by thrombosis in antiphospholipid syndrome (APS).[1][2] Venous thrombosis can occur as deep vein thrombosis in the lower limb or upper limb, or as venous thrombosis in less common sites such as mesenteric, renal, or portal veins. Venous thromboembolism will present as pulmonary embolism.
APS has a predilection for thrombosis in the brain and can cause the typical presentation of stroke or cerebral venous sinus thrombosis, or cause small-vessel periventricular infarcts, or occasionally affect small vessels and cause syndromes such as sudden sensorineural hearing loss. In the heart it can cause a thrombotic myocardial infarction in coronary vessels not affected by atherosclerosis. It can also affect small vessels such as the renal vasculature, resulting in a thrombotic microangiopathy. Occasionally patients may present with bone necrosis due to thrombosis of the supplying arteries or microvasculature. Less than 1% of patients with APS may present with catastrophic APS, which is the rapid development of thrombosis in the small vessels of multiple organs in the presence of antiphospholipid antibodies.
Other clinical manifestations that were not included in the Sapporo classification criteria have been included in the ACR/EULAR criteria, including thrombocytopenia, cardiac valve disease, and others.[2][4]
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