A Clinical Case of Critical Ischemia of the Lower Limb Due to Antiphospholipid Syndrome in a Patient With Newly Diagnosed Systemic Lupus Erythematosus

Abstract

Background. Antiphospholipid syndrome (APS) is a systemic autoimmune disease with a wide range of vascular and obstetric manifestations associated with thrombotic and inflammatory mechanisms initiated by antiphospholipid antibodies.
 Aims: to demonstrate an early onset of secondary APS in the newly diagnosed systemic lupus erythematosus, data literature analysis.
 Materials and methods. We analyzed the clinical case of the patient, similar clinical cases that were published, and the latest diagnostic criteria, and recommendations for the diagnosis, treatment, and prevention of APS.
 Description of the clinical case. The patient, 27 years old, was admitted to the Rheumatology department at Communal non-commercial institution "Olexandrivska Clinical Hospital" in April 2023 with complaints of phantom pain of the amputated toes of the right foot, chilliness of the hands and feet, and joint pain. 
 She has been ill since January 2021, and since then, she has had joint pain and discoloration of the skin of her fingers and feet in the cold. Significant worsening started in January 2022. The patient was hospitalized at the National Scientific Center of Surgery and Transplantology named after O.O. Shalimov, and the distal phalanges of the 1-3 toes of the right foot were amputated. As far as the patient previously had COVID-19, and took a combined oral contraceptive comprehensive differential diagnosis was carried out. The examination in the Rheumatology department revealed systemic lupus erythematosus according to diagnostic criteria ACR/EULAR 2019 and secondary antiphospholipid syndrome based on ACR/EULAR criteria 2023. The patient was prescribed hydroxychloroquine, methylprednisolone, nifedipine, iloprost, and warfarin. The patient was discharged in good condition and continues treatment ambulatory under rheumatologist control.
 Conclusion. This clinical case demonstrates the importance of a multidisciplinary approach in patients with APS. Patients with venous or arterial thrombotic events, especially young adults without risk factors, should be screened for antiphospholipid antibodies.