Acalculous ischemic gallbladder necrosis in the catastrophic antiphospholipid syndrome

Abstract

A 29-year-old woman was referred for abdominal pain. Results of tests for lupus anticoagulant and antibodies to phosphatidylserine and to P,-glycoprotein I were positive, but the patient had no features of systemic lupus erythematosus (SLE). Abdominal ultrasonography showed a thickening of the gallbladder wall without cholelithiasis. A surgical procedure revealed necrotic areas of the gallbladder wall, and a cholecystectomy was performed. Histologic examination of the gallbladder showed multiple thrombi and no vasculitis. Despite full-dose heparin, the patient developed a catastrophic antiphospholipid syndrome (APS) and subsequently died. Among connective tissue disorders, acute acalculous cholecystitis has been reported in patients with polyarteritis nodosa and/or SLE. APS should be considered as a possible cause of acalculous cholecystitis.The antiphospholipid syndrome (APS) may be responsible for diverse manifestations affecting the liver and/or gut (1,2), but to date, gallbladder involvement has not been described. We describe here a patient who developed acalculous ischemic gallbladder necrosis as a feature of catastrophic APS. CASE REPORTA 29-year-old nulliparous woman was referred for abdominal pain of recent onset. Her medical history was unremarkable. She had been taking an estrogencontaining contraceptive pill for years, and used to smoke 10 cigarettes per day. On cxaniination, she was

Imaging findings in the rare catastrophic variant of the primary antiphospholipid syndrome

“…To our knowledge, ours is the second case of acute acalculous cholecystitis in a patient suffering from CAPS [12] that has been published. It might be argued that in our patient AAC was just a secondary event, because the occurrence of AAC is known as a possible complication of major surgery; however, this is not supported by the occurrence of further ischemic manifestations of other organs.…”

Acute acalculous cholecystitis in a child with systemic lupus erythematosus

“…Dessailloud et al showed that antiphospholipid antibody syndrome can produce ACC [15]. They found multiple thrombi in the gallbladder veins and no vasculitis.…”

Catastrophic antiphospholipid syndrome in a 14-year-old child

“…Notably, in both cases abdominal pain was the presenting symptom. Although hepatic and renal involvement is common in the published APS cases, gallbladder involvement is described only in a few [15]. The small number of fragmented red cells in the peripheral blood smear is also rare [4].…”