Case History

Patient 1



Today I will share a real story of a lovely lady who visited me in 2012. She was 24-year-old happily married woman with twinkles in her eyes. She was accompanying her mother-in-law who had osteoarthritis. When she visited me again in 2015, I couldn’t recognize her, she had freckles on her face and tears in eyes. Her marriage was at the brink of being broken
On inquiring she disclosed that since she was not able to give successor to the family she was tortured regularly for not being able to give birth to a child. She had five abortions in quick succession. She never had any medical illness in the past. On investigations her blood tests were positive for antiphospholipid antibodies. She was diagnosed as a case of antiphospholipid syndrome. She was counseled and reassured. After 3 months, she reported with severe pain and blackish discoloration (gangrene) of a toe along with breathlessness because of clot in arteries. She was admitted and started on anticoagulation (blood thinner) and aspirin. She was discharged after 3 weeks with an advice to continue medicine. In 2013, she conceived again. Her medicines were changed but continued on blood thinners and aspirin. Under supervision of Obstetrician and Rheumatologist she gave birth to a healthy boy. After 5 days of her delivery she developed paralysis of left half of her body, which completely recovered with treatment within 10 days. She lost to follow-up for four years and stopped medicines at her own. She delivered her second child during this period without any complication. Again, in July 2018 she presented to emergency with very high blood pressure, seizures and unconsciousness. Her detailed evaluation revealed kidney , heart and liver dysfunction in addition to brain involvement. She was labeled as having catastrophic antiphospholipid syndrome. She was given high dose corticosteroids, immunosuppressive drugs and other supportive treatment. Fortunately, she had uneventful recovery and she was discharged after 40 days of inpatient. She is doing well on treatment She is happily married and has two healthy children.
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antibodies against phospholipids present in human cells. It is more common in females in reproductive age group. APS can present with a variety symptoms resulting from thrombosis in the blood vessels like arteries, veins and capillaries as well as obstetrical complications. Patients can present with hypertension, stroke, coronary artery disease, liver dysfunction, kidney dysfunction, and low platelets etc. Obstetric complications include unexplained recurrent early miscarriage, fetal death premature birth or fetal growth retardation and pre-eclampsia. Diagnosis of APS is based on clinical features detection of APLA like anti-cardiolipin antibodies, anti-β2-glycoprotein 1 antibodies and lupus anticoagulant. 1% of normal population can have antiphospholipid antibody (APLA) positivity, and only 2% of those having positive APLA develop the disease. Incidence of APS is ∼5 new cases per 100,000 individuals per year. Prevention of thrombotic manifestations associated with APS includes lifestyle changes and, in individuals at high risk, low-dose aspirin. Treatment of thrombotic events is mainly with the use of vitamin K antagonists (blood thinners) and immunosuppression is used sometimes. Successful live birth in outlook;70% of pregnancies is achievable with current treatment and regular follow-up with Obstetrician and Rheumatologist.




Next case history will be published on 27th March 2019.

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