[Antiphospholipid syndrome with autoimmune hemolytic anemia which mimics thrombotic thrombocytopenic purpura].
A 67-year-old woman was admitted to the hospital for lethargy, fever, hemolytic anemia, thrombocytopenia, and consciousness disturbance. Direct Coombs test was positive, and anti-cardiolipin beta2-glycoprotein I antibody was detected. She was diagnosed with antiphospholipid syndrome complicated with autoimmune hemolytic anemia (AIHA). She demonstrated variable consciousness disturbance, inability to distinguish right from left, dysgraphia and dyscalculia. Multiple cerebral infarctions, especially dominant cerebral hemisphere infarctions, were observed on magnetic resonance imaging. A ventilation-perfusion scan demonstrated the presence of a ventilation-perfusion mismatch in both lung fields, and multiple veinous embolisms in the right femoral, bilateral the great saphenous and popliteal veins. Therefore, pulmonary embolism and thrombophlebitis were diagnosed. Based on these findings, it was necessary to distinguish this diagnosis from thrombotic thrombocytopenic purpura (TTP). As ADAMTS-13 activity was within the normal range, TTP was denied. Thereafter, the patient was treated with 1 mg/kg of prednisolone for AIHA, 3 mg of warfarin, and 3500 units of low-molecular-weight heparin for thrombosis, and her condition improved.
Karasawa
Naoki
N
Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki.
Taniguchi
Yasuhiro
Y
Hidaka
Tomonori
T
Katayose
Keiko
K
Kameda
Takuro
T
Side
Kotaro
K
Shimoda
Haruko
H
Nagata
Kenji
K
Kubuki
Yoko
Y
Matsunaga
Takuya
T
Shimoda
Kazuya
K
D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D011239:Prednisolone / Q000008:administration & dosage; D011697:Purpura, Thrombotic Thrombocytopenic; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D015415:Biomarkers; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D011239:Prednisolone; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human