[Spastic tetraparesis and heart thrombus in a male patient as first symptoms of the antiphospholipid syndrome].
OBJECTIVE
The antiphospholipid syndrome (APS) manifests itself with circulating anticardiolipid antibodies (aCL) and/or lupus anticoagulant (LA) associated with thrombi and emboli or with recurrent complications of pregnancy.


METHODS
We present a case of a 50-year-old man who was diagnosed with the antiphospholipid syndrome on the basis of serologic findings and results of diagnostic imaging. Neurological symptoms in the form of memory deficits, disorders of orientation, and pyramidal-type bilateral hemiparesis more evident on the left side were reported by the patient over a period of two years. Magnetic resonance imaging (MRI) of the head revealed numerous vascular foci located in the cortical-subcortical areas of the brain. Ultrasound (USG) disclosed a large, irregular thrombus adhering to the margins of the mitral valve with signs of inflammation. aCL (high titers in both classes), LA, and anti-beta2-glycoprotein I antibodies (a-beta2GPI) were found in serum. a-beta2GPI and anti-nDNA antibodies were disclosed in the cerebrospinal fluid.


RESULTS
Combined anticoagulant and anti-aggregation therapy was unsuccessful. It was then decided to use immunosuppression with intravenous cyclophosphamide and methylprednisone pulses every 4 weeks (7 cycles). USG at follow-up showed marked regression of the mitral thrombus with swollen margins of the mitral valve. MRI of the brain confirmed progression of the lesions described previously.


CONCLUSIONS
The diagnosis of secondary antiphospholipid syndrome associated most probably with systemic lupus erythematosus (SLE) was made. It should be remembered, however, that diagnostic criteria for APL and SLE partially overlap.
Bobrowska-Snarska
Danuta
D
Klinika Reumatologii Pomorskiej Akademii Medycznej ul. Unii Lubelskiej 1, 71-252 Szczecin.
Ostanek
Lidia
L
Płońska
Edyta
E
Brzosko
Marek
M
D000974:Antibodies, Antinuclear / Q000302:isolation & purification; D017152:Antibodies, Antiphospholipid / Q000302:isolation & purification*; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D011782:Quadriplegia / Q000209:etiology*; D013927:Thrombosis / Q000209:etiology*; D016896:Treatment Outcome
D000974:Antibodies, Antinuclear; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants