title: [Complicated antiphospholid antibody syndrome].
abstract: METHODS
  A 51-year-old female patient suffered from recurrent ischemic strokes and venous thromboembolism although treated with ASS and phenprocoumon, which mainly occurred after diagnosis and treatment of an invasive-ductal mamma carcinoma. The severely ill patient presented with right-sided hemiparesis and dysarthria, a swollen leg, a painful necrotic-ulcerative lesion at the left-lateral ankle and a systolic heart murmur.
  
  
  METHODS
  Laboratory data revealed a haemoglobin of 8,4 g/dl, a leucocyte count of 3,1 x 10 (9)/l and a platelet count of 87 x 10 (9)/l. C-reactive protein, ESR and plasma fibrinogen were markedly increased. Levels of antinuclear, IgG-anticardiolipin and anti-doublestranded-DNA antibodies were excessively elevated. A test for lupus anticoagulant was strongly positive. Sonographic examinations showed deep vein thrombosis and significant mitral valve regurgitation. Suspected pulmonary embolism was demonstrated by CT scan. We diagnosed systemic lupus erythematosus with secondary antiphospholipid antibody syndrome (APAS).
  
  
  METHODS
  Phenprocoumon was stopped and full-dose anticoagulation with low-molecular-weight heparin initiated. Additional immunosuppressive therapy consisted of cyclophosphamide, azathioprin and prednisone resulting in prevention of further thromboembolism and significant improvement of clinical symptoms. The observed severe interference of LA with the prothrombin time after cessation of phenprocoumon (INR 3,6; FII activity 81 %) suggested that the effect of oral anticoagulation had been overestimated in the past.
  
  
  CONCLUSIONS
  APAS may present as an acute and life-threatening disorder. In this case interdisciplinary co-operation and a highly individualised treatment strategy are mandatory.
authors.affiliation: Zentrum für Innere Medizin, Medizinische Klinik II, Onkologie und Hämatologie, Hamburg, Germany. drflanger@aol.com
authors.forename: F
authors.initials: F
authors.lastname: Langer
authors.forename: B
authors.initials: B
authors.lastname: Eifrig
authors.forename: S
authors.initials: S
authors.lastname: Hegewisch-Becker
authors.forename: G
authors.initials: G
authors.lastname: Marx
authors.forename: K
authors.initials: K
authors.lastname: Neuber
authors.forename: D K
authors.initials: DK
authors.lastname: Hossfeld
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000175:diagnosis / Q000628:therapy*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000601:surgery*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015412:Mastectomy, Segmental; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010348:Patient Care Team; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000628:therapy; D013924:Thrombophlebitis / Q000175:diagnosis / Q000628:therapy*
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate