title: Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.
abstract: We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.
authors.affiliation: Service of Rheumatology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Mundo
authors.forename: P
authors.initials: P
authors.lastname: Peris
authors.forename: A
authors.initials: A
authors.lastname: Monegal
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: R
authors.initials: R
authors.lastname: Cervera
authors.forename: N
authors.initials: N
authors.lastname: Guañiabens
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D005271:Femur Head Necrosis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D005500:Follow-Up Studies; D006615:Hip / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000473:pathology; D007717:Knee / Q000000981:diagnostic imaging / Q000473:pathology; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D010522:Periostitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D011859:Radiography; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000473:pathology; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000925:Anticoagulants; D000074:Acenocoumarol