[Pulmonary thromboembolism in antiphospholipid syndrome].
A 37-year-old woman in acute right heart failure had experienced systemic venous thromboses for 17 years, five miscarriages and repeated pulmonary emboli. For the last 7 years she had been treated symptomatically for pulmonary hypertension. The platelet count was 62,000/microliters, thromboplastin time under phenprocoumon was 22%, partial thromboplastin time was 72 s. Despite anticoagulation with phenprocoumon and heparin (7,500 IU two times daily subcutaneously) new pulmonary emboli occurred and platelet count fell to 12,000/microliters. An increased titre for anticardiolipin antibodies (IgG > 320 GPL U/l, IgM 8 MPL U/l), antinuclear (1:640) and anti-ds-DNA antibodies (> 200 IU/ml) with simultaneous complement consumption suggested secondary antiphospholipid syndrome associated with lupus erythematodes. Treatment with prednisolone (150 mg/d), immunoglobulins (20 mg/d intravenously for 5 days) and heparin (25,000 IU/24 h intravenously) achieved an increase in platelet count to 200,000/microliters within 10 days, but fell again when the prednisolone dose was reduced, recovering under azathioprine, 150 mg/d. Four weeks later the patient died of renewed acute right heart failure.
Abteilung Immunologie und Transfusionsmedizin, Zentrums Innere Medizin und Dermatologie der Medizinischen Hochschule Hannover.
F L
FL
Dumoulin
W G
WG
Daniel
P
P
Lichtlen
R E
RE
Schmidt
D000208:Acute Disease; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000302:isolation & purification; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000276:immunology; D001780:Blood Coagulation Tests; D002308:Cardiolipins / Q000276:immunology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D011655:Pulmonary Embolism / Q000209:etiology*; D013921:Thrombocytopenia / Q000097:blood; D013923:Thromboembolism / Q000209:etiology
D017152:Antibodies, Antiphospholipid; D002308:Cardiolipins
Pulmonale Thromboembolien bei Antiphospholipid-Syndrom.