title: Fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery for a pituitary tumor: A case report.
abstract: BACKGROUND
  The fatal type of antiphospholipid syndrome is a rare but life-threating condition. It may be triggered by surgery or infection. Endoscopic transnasal-transsphenoidal surgery is a common procedure for pituitary tumor. We report a catastrophic case of a young woman died of fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery.
  
  
  RESULTS
  A 31-year-old woman of a history of stroke received endoscopic transnasal-transsphenoidal surgery for a pituitary tumor. The whole procedure was smooth. However, the patient suffered from acute delirium on postoperative day 4. Then, her consciousness became comatose state rapidly with dilatation of pupils. Urgent magnetic resonance imaging of brain demonstrated multiple acute lacunar infarcts. The positive antiphosphoipid antibody and severe thrombocytopenia were also noted. Fatal antiphospholipid syndrome was diagnosed. Plasma exchange, corticosteroids, anticoagulant agent were prescribed. The hemodynamic condition was gradually stable. However, the consciousness was still in deep coma. The patient died of organ donation 2 months later.
  
  
  CONCLUSIONS
  If patients have a history of cerebral stroke in their early life, such as a young stroke, the APS and higher risk of developing fatal APS after major surgery should be considered. The optimal management of APS remains controversial. The best treatment strategies are only early diagnosis and aggressive therapies combing of anticoagulant, corticosteroid, and plasma exchange. The intravenous immunoglobulin is prescribed for patients with refractory APS.
authors.affiliation: Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei Department of Surgery, Kaohsiung Armed Forces General Hospital Department of Surgery, Zoying Branch, Kaoshiung Armed Forces General Hospital Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chiao-Zhu
authors.initials: CZ
authors.lastname: Li
authors.forename: Chiao-Ching
authors.initials: CC
authors.lastname: Li
authors.forename: Chih-Chuan
authors.initials: CC
authors.lastname: Hsieh
authors.forename: Meng-Chi
authors.initials: MC
authors.lastname: Lin
authors.forename: Dueng-Yuan
authors.initials: DY
authors.lastname: Hueng
authors.forename: Feng-Chen
authors.initials: FC
authors.lastname: Liu
authors.forename: Yuan-Hao
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D020520:Brain Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects / Q000379:methods; D008279:Magnetic Resonance Imaging; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D010951:Plasma Exchange / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
chemical_list: D000925:Anticoagulants; D005938:Glucocorticoids