Jean-Charles Piette, MD; Zahir Amoura, MD; Anne Foucher-Lavergne, MD
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Piette J, Amoura Z, Foucher-Lavergne A. “Catastrophic” Diagnosis of the Antiphospholipid Syndrome. Ann Intern Med. 1999;131:798-799. doi: 10.7326/0003-4819-131-10-199911160-00036
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Published: Ann Intern Med. 1999;131(10):798-799.
TO THE EDITOR:
A 41-year-old male smoker developed blurred vision, right arm weakness, and aphasia. Examination showed no heart murmur and multiple subungual hemorrhages. Lupus anticoagulant was detected, with low levels of anticardiolipin and antinuclear antibodies and no cryoglobulin, double-stranded DNA, or extracted nuclear antigen antibodies. Magnetic resonance imaging showed a left parietal infarction. Echocardiography revealed mitral vegetations (Figure). Funduscopy showed retinal vein occlusion. Blood cultures remained negative.
The patient was referred for the antiphospholipid syndrome. Atypical findings—dorsalgia, cervical lymphadenopathy, fever, and weight loss—led to further work-up. Bronchoscopy showed a tracheal lesion that was negative on biopsy; node smears were also negative. Magnetic resonance imaging demonstrated a T3 image, which was diagnosed on biopsy as mucosecreting carcinoma metastasis. Mechanical hemolysis (regenerative anemia with schistocytes, negative results on the Coombs test, and low haptoglobin level) and disseminated intravascular coagulation were evident. Serum CA15.3 level was extremely elevated. Lupus anticoagulant and high levels of IgG anticardiolipin antibodies were present, without antibodies to β2-glycoprotein I. The patient died after developing left hemiparesis and respiratory distress. Autopsy confirmed carcinoma of unknown origin with lung miliary, thrombotic nonbacterial mitral vegetations, and renal and cerebral infarctions.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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