Herlyn Werner Wunderlich Syndrome Presenting with Ischemic Stroke due to Suspected Paroxysmal Nocturnal Hemoglobinuria: A Case Report

Abstract

Paroxysmal nocturnal hemoglobinuria can rarely present as cerebral ischemia and stroke due to arterial thrombosis. However, it should be considered in a young patient with bone marrow failure features, systemic thromboses, and hemolysis. The variants of paroxysmal nocturnal hemoglobinuria pose a diagnostic challenge and hence are important to recognize. We report a case of a 28-years-old female with Herlyn Werner Wunderlich Syndrome who presented with an ischemic cerebrovascular accident, pancytopenia, hemoglobinuria, and widespread abdominal thromboses suggestive of paroxysmal nocturnal hemoglobinuria. The patient was managed symptomatically and referred toa hematologist.

The Impact of Standardized Health Education in Patients with Ischemic Stroke on Patient Management Satisfaction and Quality of Clinical Management Services

“…Ischemic stroke is a common vascular brain illness with a complex pathogenesis that is significantly associated with environmental, genetic, and acquired genetic factors [ 1 , 2 ]. Ischemic stroke is a condition in which patient's cerebral arteries are blocked, resulting in a dysfunctional blood supply to the brain, leading to partial brain tissue necrosis, which severely affects the patient's neurological function [ 3 , 4 ].…”

Eculizumab for paroxysmal nocturnal haemoglobinuria: catastrophic health expenditure in Nepalese patients

“…PNH is often misdiagnosed with different types of anemia: iron deficiency, hemolytic, megaloblastic or refractory, and sometimes as myelodysplastic syndromes [7,9]. Dr. Acharya et al reported a case of a 28-year-old Nepalese woman with Herlyn Werner Wunderlich syndrome who presented with an ischemic cerebrovascular accident, pancytopenia, hemoglobinuria, and widespread abdominal thromboses suggestive of paroxysmal nocturnal hemoglobinuria [11] A PNH clone flow cytometry test was recommended, but due to the unavailability of the test in Nepal, a nationwide lockdown due to the coronavirus pandemic, and the poor financial situation of the patient, the test could not be performed [11]. This case is just the tip of the iceberg and vividly represents the plight of patients with PNH in less resourced nations like Nepal.…”