Nelson S. Yee, MD, PhD; Stephen J. Schuster, MD; Gary R. Lichtenstein, MD
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Yee NS, Schuster SJ, Lichtenstein GR. Ischemic Colitis Associated with Anti-β2 Glycoprotein-I Antibody. Ann Intern Med. 2002;137:299. doi: 10.7326/0003-4819-137-4-200208200-00027
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Published: Ann Intern Med. 2002;137(4):299.
TO THE EDITOR:
Ischemic colitis associated with the antiphospholipid syndrome has been attributed to lupus anticoagulants and anticardiolipin antibodies. Anti-β2 glycoprotein-I antibodies appear to correlate more closely with the diagnosis of the antiphospholipid syndrome than antiphospholipid antibodies (1), and they increase the risk for deep venous thrombosis and pulmonary embolism in patients without systemic lupus erythematosus (2, 3). We report a case of ischemic colitis in a woman who used oral contraceptives and had elevated levels of anti-β2 glycoprotein-I IgM antibodies.
A 25-year-old nonsmoking woman who had used oral contraceptives for 2 years presented with abrupt onset of severe abdominal pain and bloody diarrhea. Tenderness in the left lower quadrant of the abdomen and a midsystolic murmur were noted. Colonoscopy revealed extensive superficial ulcerations with focal petechial hemorrhage in the distal descending colon, and colonic biopsy showed mucosal necrosis with edema and hemorrhage consistent with ischemic colitis. The mesenteric arteries and veins appeared normal on magnetic resonance angiography. Thrombophilic evaluation was remarkable for elevated levels of anti-β2 glycoprotein-I IgM antibody (20.5 U [normal value <12.9 U]), whereas levels of anti-β2 glycoprotein-I IgG, anticardiolipin antibodies (IgG and IgM) and lupus anticoagulants (dilute Russell viper venom test) were within normal limits. Levels of protein C, protein S, antithrombin III, plasminogen, and homocysteine, as well as results of tests for factor V Leiden mutation and prothrombin G20210A mutation, were unremarkable. Echocardiography with contrast revealed mild mitral regurgitation. The patient discontinued oral contraceptives, her abdominal symptoms resolved during anticoagulant therapy with warfarin, and she had no subsequent thrombotic event over the next 15 months.
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