The antiphospholipid antibody syndrome: a case report

Abstract

Antiphospholipid antibody syndrome is defined by the presence of thromboembolic complications and/or pregnancy morbidity in the presence of persistently increased titers of antiphospholipid antibodies. Its clinical presentation can be diverse and any organ can be involved, with a current impact in most surgical and medical specialties. The authors present the case of a 43-year-old man who, over a 13-year period of follow-up, presented with thrombosis of the mesenteric vein, inferior vena cava, and axillary and subclavian veins in a setting where diagnostic and therapeutic options are limited and costly. Through this case report, the authors aim to describe the evolution of this complex pathology, which to date has not been described in the authors’ milieu – probably because of its challenging diagnosis and the limited treatment options available. The authors conclude that clinicians need to have a high index of suspicion of APS in patients who present with a thrombotic episode – clinicians should investigate for the presence of antiphospholipid antibodies, as early diagnosis may influence the course of the disease. Furthermore, resources for the detection of antiphospholipid antibodies should be made readily available in resource-limited settings. Finally, patient education on the importance of drug compliance, periodic monitoring, and prevention of thrombosis is indispensable, especially as mortality could be associated with the effects of vascular thrombosis and/or the effects of bleeding due to anticoagulants.

Challenges in the diagnosis and management of anti-phospholipid syndrome: a case from Cameroon

“…This is the second documented case of APLS in our country after that reported by Luma et al in a 43-year-old man [ 2 ]. This suggests under diagnosis and under reporting of APLS, in the context of limited access to diagnostic tests.…”

“…In our case, the patient, despite being on medical aid., missed many medical visits and laboratory tests while on acenocoumarol. This non-compliance was even worse in the case reported by Luma et al since their patient did not probably benefit from any form of medical aid [ 2 ]. Even in treated patients, especially with the more available and affordable acenocoumarol, the risk of recurrent thrombo-embolic events remains high as shown in our case (treated with acenocoumarol) and that reported by Luma et al (treated with aspirin).…”

“…The epidemiology of APLS in our low-income setting is unknown, probably due to under-diagnosis and under-reporting. Indeed, the diagnostic tests for APLS are unavailable in most health facilities and the treatment options are limited [ 2 ]. We present here the second reported case of APLS in Cameroon, and highlight challenges in diagnosis and management.…”

Anesthetic management in a case of antiphospholipid antibody syndrome

“…Although the pathogenesis of this syndrome is poorly understood, many mechanisms have been described, one being binding of APLAs to endothelial cells, which stimulates an up-regulation of the adhesion molecules and an increase leukocyte adhesion leading to a prothrombic state. [ 4 5 ] Most recently a catastrophic antiphospholipid variant with a mortality rate of approximately 50% has been described. [ 6 ] In the pregnant uterus, the fetoplacental endothelium is mainly targeted thus interfering with the implantation of the embryo causing recurrent abortion.…”