title: Intracerebral hemorrhage in a patient with SLE and catastrophic antiphospholipid syndrome (CAPS): report of a case.
abstract: A 31-year-old woman was admitted to the hospital for investigation of left lower limb thrombophlebitis. History, physical examination, and laboratory investigations led to the diagnosis of systemic lupus erythematosus (SLE), complicated by secondary antiphospholipid syndrome (APS). Treatment included steroids, azathioprine, aspirin, and low molecular weight heparin. Sixty-three days later, she was admitted to the hospital again because of high fever, macroscopic hematuria, and dyspnea. Laboratory testing showed anemia and impaired renal function. High-resolution chest computed tomography (CT) revealed bilateral multiple peribronchial infiltrates with hemorrhage. Magnetic resonance imaging (MRI) angiography of the kidneys revealed left renal vein thrombosis combined with ischemia of the left kidney. Cyclophosphamide and methylprednisolone pulse treatment as well as intravenous immunoglobulins were started immediately. Despite intensive immunosuppressive and supportive treatment, she suffered three relapses of alveolar hemorrhage and died on day 40, due to severe intracerebral bleeding. The final diagnosis was catastrophic APS with diffuse alveolar hemorrhage and kidney involvement. The unusual combination of recurrent alveolar hemorrhage and death from intracerebral hemorrhage rather than thrombosis in a CAPS patient is discussed.
authors.affiliation: Internal Medicine and Clinical Immunology, 2nd Department of Internal Medicine, Hippokration General Hospital, Aristotelian University of Thessaloniki, Greece. boura@med.auth.gr
authors.forename: Panagiota
authors.initials: P
authors.lastname: Boura
authors.forename: Savas
authors.initials: S
authors.lastname: Papadopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tselios
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Skendros
authors.forename: Olga
authors.initials: O
authors.lastname: Dioritou
authors.forename: Georgios
authors.initials: G
authors.lastname: Malamis
authors.forename: Pantelis
authors.initials: P
authors.lastname: Makris
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Lefkos
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D001774:Blood Chemical Analysis; D003131:Combined Modality Therapy; D016638:Critical Illness; D018450:Disease Progression; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000379:methods; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods