Spontaneous Hematoma of Upper Extremities in a Patient with Antiphospholipid Antibody Syndrome: A Case Report

Abstract

A 44-year-old woman with underlying systemic lupus erythematosus and antiphospholipid antibody syndrome presented with nausea and vomiting after her 2nd vaccination for coronavirus disease 2019 (COVID-19). Thirteen days after warfarin injection was administered along with steroid therapy, the patient suffered sudden right shoulder pain, paresthesia, and swelling, suggesting acute compartment syndrome. The warfarin regimen was bridged to low molecular weight heparin and fasciotomy was performed. Multiple hematoma evacuation after fasciotomy was done and the patient was referred for skin necrosis. Frequent debridement and negative pressure wound therapy were performed to heal the right upper extremity skin defect. Afterwards, the patient experienced hemorrhage in her left upper extremity and was treated conservatively with simple compression. This report suggests that patients undergoing anticoagulation therapy for antiphospholipid syndrome should be closely monitored for subcutaneous hemorrhage, and that prompt diagnosis and treatment may prevent adverse results. If massive skin necrosis occurs, multiple surgical debridement procedures and application of negative pressure wound therapy may be an option.