Hepatic infarction in a pregnant woman with antiphospholipid syndrome and triple antibody positivity: A case report focusing on catastrophic antiphospholipid syndrome.
Pregnant women with antiphospholipid syndrome (APS) carry a high risk of arterial or venous thrombosis. Such thrombotic conditions occur more frequently in patients with triple positivity to antiphospholipid antibodies or with high antibody titers. Hepatic infarction is a rare complication in pregnant women with APS, and it sometimes mimics HELLP syndrome. This report describes a preeclamptic pregnant woman with APS who had high titers of three antiphospholipid antibodies. She experienced severe epigastric pain with elevated liver enzymes; in addition, she had tachycardia and tachypnea. The clinical findings suggested hepatic infarction and pulmonary thromboembolism, a partial manifestation of catastrophic APS. Therefore, she underwent emergent cesarean section at 25+2 weeks of gestation. After the delivery, her laboratory test indicated HELLP-like features, and computed tomography confirmed hepatic infarction and pulmonary micro-thromboembolism. Here, we report a case of a partial manifestation of catastrophic APS in a pregnant woman with triple antibody positivity, including a brief literature review.
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ji-Hye
JH
Kim
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cheonga
C
Yee
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jin-Yi
JY
Kuk
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Suk-Joo
SJ
Choi
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Soo-Young
0000-0003-3002-0048
SY
Oh
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cheong-Rae
CR
Roh
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jong-Hwa
JH
Kim
Antiphospholipid antibodies; Catastrophic antiphospholipid syndrome; HELLP syndrome; Hepatic infarction; Triple antibody positivity
Autoimmun Rev. 2015 Jun;14(6):498-502
25617818
J Thromb Haemost. 2003 Aug;1(8):1758-63
12911590
Ann Rheum Dis. 2007 Jun;66(6):740-6
17223653
Clin Exp Rheumatol. 2013 May-Jun;31(3):382-8
23305633
Arch Gynecol Obstet. 2011 Mar;283(3):659-62
20411270
Medicine (Baltimore). 2001 Nov;80(6):355-77
11704713
Lupus. 2006;15(3):172-8
16634372
Lancet. 2010 Oct 30;376(9751):1498-509
20822807
Ann Rheum Dis. 2005 Feb;64(2):273-8
15647435
Autoimmun Rev. 2015 May;14(5):387-95
25555817
Lupus. 2003;12(7):530-4
12892393
Autoimmun Rev. 2014 Jun;13(6):685-96
24468415
Arthritis Rheum. 1989 Apr;32(4):491-5
2495803
Autoimmun Rev. 2015 Sep;14(9):760-2
25936295
Rheumatology (Oxford). 2013 Sep;52(9):1635-41
23676524