The antiphospholipid antibody syndrome in the emergency department setting--livedo reticularis and recurrent venous thrombosis.
We present the case of a 26-year-old man with an exacerbation of apparent chronic asthma with chronic peripheral vascular disease due to recurrent venous thrombosis. Localized livedo reticularis, new cutaneous infarctions, severe venous insufficiency, thrombocytopenia, renal failure, and cerebral supratentorial dysfunction were noted. During hospital admission, antibodies to phospholipids in high titer were present by three different testing methods. Renal biopsy demonstrated significant renal vasculature abnormalities characteristic of hemolytic endovasculopathy, and magnetic resonance imaging showed multiple cerebral infarctions. This case exemplifies the spectrum of presentations and management of the primary antiphospholipid antibody syndrome. The clue to its presence in this patient was the livedo reticularis rash, a cutaneous marker for this syndrome that was evident in the emergency department.
Kester
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Department of Emergency Medicine, Oklahoma University Health Sciences Center, Oklahoma City.
McCarty
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McCarty
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D000328:Adult; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001249:Asthma / Q000150:complications; D003951:Diagnostic Errors; D004417:Dyspnea / Q000209:etiology*; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D012008:Recurrence; D012867:Skin / Q000098:blood supply; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology*; D013924:Thrombophlebitis / Q000209:etiology*