Intra-cardiac thrombus in antiphospholipid antibody syndrome: An unusual cause of fever of unknown origin with review of literature

Abstract

Antiphospholipid antibody syndrome (APS) commonly presents with thrombotic events, pregnancy morbidity, and recurrent pregnancy loss [1]. APS presenting as fever of unknown origin (FUO) is rare. To date, there are only a few case reports that have described FUO as presenting manifestation of APS [2]. Intra-cardiac thrombus and pulmonary thromboembolism (PTE) are lifethreatening thrombotic events of APS, but asymptomatic presentation of intra-cardiac thrombus with PTE is rare [3]. Case reportA 41-year-old man presented with 4-months history of highgrade fever, 38.8-40 8C, associated with chills and rigor, 1-2 episodes per month. Each episode used to last for 1-2 days followed by spontaneous resolution of symptoms. During this time, he also had significant loss of appetite with weight loss of $15 kg. There was no other history to suggest localization. On evaluation he was febrile, normotensive with tachycardia (heart rate -100/min) no tachypnea, and was maintaining room air oxygen saturation of 97%. He had average build (body mass index -21.70 kg/m 2 ), grade-I pan-digital clubbing and there was no palpable lymph node or hepatosplenomegaly. Cardiovascular examinations revealed a systolic click at 3rd inter-costal space, near left parasternal area with no appreciable variation of intensity during respiration and there was no definitive thrill or murmur. Other systemic examinations were essentially normal. Clinically, differential diagnosis of sub-acute bacterial endocarditis, tuberculosis, human immunodeficiency virus (HIV) infection, occult malignancy, lymphoma, or any autoimmune phenomena were considered. Investigations revealed thrombocytopenia (25 Â 10 9 / L) with normal hemoglobin (Hb-13.5 g/dL) and total leucocytes count (TLC-7 Â 10 9 /L). Blood and urine cultures were sterile multiple times. Chest X-ray showed mild broncho-vascular

Co-existing Bilateral Pulmonary Embolism and Intra-cardiac Mass: A Case of Catastrophic Antiphospholipid Syndrome-like Disease

“…Antiphospholipid syndrome (APLS) is a heterogeneous autoimmune disorder of hyper coagulation. It is manifested mostly as arterial and venous thrombosis, recurrent fetal loss and thrombocytopenia [ 1 ] and by presence of antiphospholipid antibodies (aPL) such as anticardiolipin antibodies and lupus anticoagulant [ 2 ]. Antiphospholipid syndrome has varying presentations and can manifest in any organ system thus requiring multidisciplinary team for optimal management.…”

Atrial thrombus as a complication of SLE and APS in an 8-year-old child

“…In this case, our patient had a right atrial thrombosis that was associated with secondary APS, which has a higher risk of thrombosis and valvular disease than patients who do not have antiphospholipid antibodies [ 15 ]. In addition, others [ 10 , 16 , 17 ] have pointed out that when the thrombus in the cardiac cavity is large and irregular, it easly falls off and leads to a very high risk of recurrent pulmonary embolism. In this patients, pulmonary CT showed inflammation and consolidation changes in both lungs (Fig.…”

Left ventricular thrombus: An interesting presentation of primary antiphospholipid antibody syndrome with a mini-review of the literature

“…[ 5 ] Although intracardiac thrombus is rare, it is reported to be most common in the right atrium and is more frequently associated with P-APLS as compared to S-APLS. [ 6 ] Although there are no data specific to LV thrombus, available literature suggests that the presence of high levels of LA and aCL was significantly associated with arterial[ 7 ] and intracardiac thrombosis. [ 8 ] A 5-year prospective study also showed that the median time to a recurrent thrombotic event is shorter in patients with high titer of aCL antibody and intracardiac thrombus.…”