Olgu Sunumu
BibTex RIS Kaynak Göster

Multipl Skleroz Olarak Yanlış Teşhis Edilen Antifosfolipid Sendromu: Bir Olgu Sunumu.

Yıl 2022, , 580 - 586, 19.07.2022
https://doi.org/10.20515/otd.978880

Öz

Multipl skleroz ve anti-fosfolipid sendromu (AFAS), genç yetişkinleri etkileyen kronik, immün aracılı, relapsing-remitting bozukluklardır. AFAS, anti-fosfolipid antikorları ile ilişkili tromboz ve gebelik mortalitesi ile karakterizedir. AFAS tanısı zor olabilir ve AFAS’lı hastaların yanlış multipl skleroz tanısı alması nadir değildir. Bu olgu sunumunda, on bir yıldır multipl skleroz tanısı ile izlenen bir hastayı tanımladık. Başlangıçta hastanın MS benzeri relapsing- remitting seyirli nörolojik defisitleri vardı ancak MS'in klasik manyetik rezonans görüntüleme görünümü ve beyin omurilik sıvısında oligoklonal bantlar yoktu. Hasta MS tanı kriterlerinde belirtilen ‘zamanda ve mekanda yayılım kriterleri’ ni karşılamıyordu. Ayrıca farklı zamanlarda akut miyokard infarktüsü ve iskemik inme geçirmişti. Primer AFAS tanısı, hastanın iskemik serebral inme geçirmesi, nöbet ve iki kez aPL pozitif olması üzerine konuldu. Gözlemlerimiz, AFAS’ın erken ve doğru teşhisinin önemi konusunda farkındalık yaratmaktadır. MS hastalarını değerlendirirken, klinisyenler MS'nin atipik özellikleri varsa AFAS’ı düşünmelidir.

Kaynakça

  • Referans 1 Myakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.
  • Referans 2. Laura Durcan and Michelle Petri. Epidemiology of the Antiphospholipid Syndrome Chapter 2. Handbook of Systemic Autoimmune Diseases. 2017;12:17-30.
  • Referans 3. Yoav Arnson, Yehuda Shoenfeld, Eisen Alon and Howard Amita. Antiphosholipid syndrome as neurological disease. Semin Arthritis Rheum. 2010; 40:97-108.
  • Referans 4. Andrew J, Solomon, Brain G. Weinshenker. Misdiagnosis of multiple sclerosis: Frequency, Causes, Effects, and Prevention. Curr. Neurol neurosci Rep. 2013; 13:403.
  • Referans 5. Cervera R, Piette JC, Front J, et al. Antiphospkolipid syndrome:clinical and immunologic manifestations and patterns of disease expression in a cohort of 1.000 patients. Arthritis rheum. 2002;46:1019-27.
  • Referans 6. Sanna G, Bertolaccini ML, Cuadrado MJ, et al. Central nervous system involvement in the antiphospholipid (Hughes) syndrome. Rheumatology. 2003;42:200-13.
  • Referans 7. Lockshin M, Tenedios F, Petri M, et al. Cardiac disease in the antiphospholipid syndrome:recommendations for treatment. Committee consensus report. Lupus. 2003;12:518-23.
  • Referans 8. Guillermo RI, Crowther M, Branch W, et al. Anti-phospholipid syndrome. Lancet. 2010;376:1498-1509.
  • Referans 9. Hughes GR. Thrombosis,abortion,cerebral disease,and the lupus anticoagulant. Br Med J (Clin Res Ed). 1983; 287(6399): 1088–1089.
  • Referans 10. Sanna G, D’Cruz D,Cuadrado MJ. Cerebral manifestations in the antiphospholipid (Hughes) syndrome. Rheum Dis Clin North Am. 2006; 32(3): 465–490.
  • Referans 11. Yelnik CM, Kozora E, Appenzeller S. Non-stroke central neurologic manifestations in antiphospholipid syndrome. Curr Rheumatol Rep. 2016; 18(2): 11.
  • Referans 12. Rodrigues CEM, Carvalho JF, Shoenfeld Y. Neurological manifestations of anti- phospholipid syndrome. Eur J Clin Invest. 2010; 40(4): 350–359.
  • Referans 13. Gris JC, Nobile B, Bouvier S. Neuropsychiatric presentations of antiphospholipid antibodies. Thromb Res. 2015; 135 (Suppl 1): S56–S59.
  • Referans 14. Fernandez-Fernandez FJ,Rivera-Gallego A,de la Fuente-Aguado J, et al. Antiphospholipid syndrome mimicking multiple sclerosis in two patients. Eur J Intern Med. 2006; 17(7): 500–502.
  • Referans 15. Cuadrado MJ, Khamashta MA, Ballesteros A, et al. Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature. Medicine (Baltimore). 2000; 79(1): 57–68.
  • Referans 16. Zhu, D.-.S., Fu, J., Zhang, Y, et al. Neurological antiphospholipid syndrome: clinical, neuroimaging, and pathological characteristics. J. Neurol. Sci. 2014; 346 (1–2), 138–144.
  • Referans 17. Keiserman B, da Silva LF, Keiserman MW, et al. Lupoid sclerosis. Rheumatol Int. 2010;30:431–4.
  • Referans 18. Heinzlef O, Weill B, Johanet C, et al. Anticardiolipin antibodies in patients with multiple sclerosis do not represent a subgroup of patients according to clinical, familial, and biological characteristics. J Neurol Neurosurg Psychiatry. 2002; 72(5): 647–649.
  • Referans 19. Liedorp M, Sanchez E, van Hoogstraten IMW, et al. No evidence of misdiagnosis in patients with multiple sclerosis and repeated positive anticardio- lipin antibody testing based on magnetic resonance imaging and long term follow-up. J Neurol Neurosurg Psychiatry. 2007; 78(10): 1146–1148.
  • Referans 20. Bidot CJ, Horstman LL, Jy W, et al. Clinical and neuroimaging correlates of antiphospholipid antibodies in multiple sclerosis: A preliminary study. BMC Neurol. 2007; 7: 36.
  • Referans 21. Szmyrka-Kaczmarek M, Pokryszko-Dragan A, Pawlik B, et al. Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis. Lupus. 2012; 21: 412–420.
  • Referans 22. Karussis D, Leker RR, Ashkenazi A, et al. A subgroup of multiple sclerosis patients with anticardiolipin antibodies and unusual clinical manifestations: Do they represent a new nosological entity? Ann Neurol. 1998; 44: 629–634.
  • Referans 23. Baraczka K, Lakos G, Sipka S. Immunoserological changes in the cerebro-spinal fluid and serum in systemic lupus erythematosus patients with demyelinating syndrome and multiple sclerosis. Acta Neurol Scand. 2002; 105: 378–383.
  • Referans 24. Roussel V, Yi F, Jauberteau MO, et al. Prevalence and clinical significance of anti-phospholipid antibodies in multiple sclerosis: A study of 89 patients. J Autoimmun. 2000; 14: 259–265.
  • Referans 25. Garg N, Zivadinov R, Ramanathan M, et al. Clinical and MRI correlates of autoreactive antibodies in multiple sclerosis patients. J Neuroimmunol. 2007; 187: 159–165.
  • Referans 26. Maria J Cuadrado, Munther A. Khamashta, Angel Ballesteros, et al. Can Neurologic manifestations of Hughes (Antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literatüre. Medicine. 2000;Vol (79) No.1:57-68.

Anti-Phosholipid Syndrome Misdiagnosed As Multiple Sclerosis: A Case Report.

Yıl 2022, , 580 - 586, 19.07.2022
https://doi.org/10.20515/otd.978880

Öz

Multiple sclerosis (MS) and anti-phospholipid syndrome (APS) are chronic, immune-mediated, relapsing-remitting disorders affecting young adults. APS is characterized by thrombosis and pregnancy mortality associated with anti-phospholipid antibodies. The diagnosis of APS may be difficult, and it is not uncommon for patients with APS to be misdiagnosed with multiple sclerosis. In this case report, we describe a patient who was diagnosed as having multiple sclerosis for eleven-year. Initially, the patient had neurological deficits with relapsing-remitting courses, like MS but he had not classic magnetic resonance imaging appearance of MS and absence of oligoclonal bands in the cerebrospinal fluid. He did not meet the 'dissemination criteria in time and place' specified in the MS diagnostic criteria. Also, he had an acute myocardial infarction and ischemic stroke at different times. The diagnosis of primary APS was made after the patient had thrombotic attacks, seizure and was positive for anti-phospholipid antibodies (aPLs) twice. Our observations raise awareness about the importance of the early and correct diagnosis of APS. When assessing MS patients, clinicians should consider APS, if the MS has atypical features.

Kaynakça

  • Referans 1 Myakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.
  • Referans 2. Laura Durcan and Michelle Petri. Epidemiology of the Antiphospholipid Syndrome Chapter 2. Handbook of Systemic Autoimmune Diseases. 2017;12:17-30.
  • Referans 3. Yoav Arnson, Yehuda Shoenfeld, Eisen Alon and Howard Amita. Antiphosholipid syndrome as neurological disease. Semin Arthritis Rheum. 2010; 40:97-108.
  • Referans 4. Andrew J, Solomon, Brain G. Weinshenker. Misdiagnosis of multiple sclerosis: Frequency, Causes, Effects, and Prevention. Curr. Neurol neurosci Rep. 2013; 13:403.
  • Referans 5. Cervera R, Piette JC, Front J, et al. Antiphospkolipid syndrome:clinical and immunologic manifestations and patterns of disease expression in a cohort of 1.000 patients. Arthritis rheum. 2002;46:1019-27.
  • Referans 6. Sanna G, Bertolaccini ML, Cuadrado MJ, et al. Central nervous system involvement in the antiphospholipid (Hughes) syndrome. Rheumatology. 2003;42:200-13.
  • Referans 7. Lockshin M, Tenedios F, Petri M, et al. Cardiac disease in the antiphospholipid syndrome:recommendations for treatment. Committee consensus report. Lupus. 2003;12:518-23.
  • Referans 8. Guillermo RI, Crowther M, Branch W, et al. Anti-phospholipid syndrome. Lancet. 2010;376:1498-1509.
  • Referans 9. Hughes GR. Thrombosis,abortion,cerebral disease,and the lupus anticoagulant. Br Med J (Clin Res Ed). 1983; 287(6399): 1088–1089.
  • Referans 10. Sanna G, D’Cruz D,Cuadrado MJ. Cerebral manifestations in the antiphospholipid (Hughes) syndrome. Rheum Dis Clin North Am. 2006; 32(3): 465–490.
  • Referans 11. Yelnik CM, Kozora E, Appenzeller S. Non-stroke central neurologic manifestations in antiphospholipid syndrome. Curr Rheumatol Rep. 2016; 18(2): 11.
  • Referans 12. Rodrigues CEM, Carvalho JF, Shoenfeld Y. Neurological manifestations of anti- phospholipid syndrome. Eur J Clin Invest. 2010; 40(4): 350–359.
  • Referans 13. Gris JC, Nobile B, Bouvier S. Neuropsychiatric presentations of antiphospholipid antibodies. Thromb Res. 2015; 135 (Suppl 1): S56–S59.
  • Referans 14. Fernandez-Fernandez FJ,Rivera-Gallego A,de la Fuente-Aguado J, et al. Antiphospholipid syndrome mimicking multiple sclerosis in two patients. Eur J Intern Med. 2006; 17(7): 500–502.
  • Referans 15. Cuadrado MJ, Khamashta MA, Ballesteros A, et al. Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature. Medicine (Baltimore). 2000; 79(1): 57–68.
  • Referans 16. Zhu, D.-.S., Fu, J., Zhang, Y, et al. Neurological antiphospholipid syndrome: clinical, neuroimaging, and pathological characteristics. J. Neurol. Sci. 2014; 346 (1–2), 138–144.
  • Referans 17. Keiserman B, da Silva LF, Keiserman MW, et al. Lupoid sclerosis. Rheumatol Int. 2010;30:431–4.
  • Referans 18. Heinzlef O, Weill B, Johanet C, et al. Anticardiolipin antibodies in patients with multiple sclerosis do not represent a subgroup of patients according to clinical, familial, and biological characteristics. J Neurol Neurosurg Psychiatry. 2002; 72(5): 647–649.
  • Referans 19. Liedorp M, Sanchez E, van Hoogstraten IMW, et al. No evidence of misdiagnosis in patients with multiple sclerosis and repeated positive anticardio- lipin antibody testing based on magnetic resonance imaging and long term follow-up. J Neurol Neurosurg Psychiatry. 2007; 78(10): 1146–1148.
  • Referans 20. Bidot CJ, Horstman LL, Jy W, et al. Clinical and neuroimaging correlates of antiphospholipid antibodies in multiple sclerosis: A preliminary study. BMC Neurol. 2007; 7: 36.
  • Referans 21. Szmyrka-Kaczmarek M, Pokryszko-Dragan A, Pawlik B, et al. Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis. Lupus. 2012; 21: 412–420.
  • Referans 22. Karussis D, Leker RR, Ashkenazi A, et al. A subgroup of multiple sclerosis patients with anticardiolipin antibodies and unusual clinical manifestations: Do they represent a new nosological entity? Ann Neurol. 1998; 44: 629–634.
  • Referans 23. Baraczka K, Lakos G, Sipka S. Immunoserological changes in the cerebro-spinal fluid and serum in systemic lupus erythematosus patients with demyelinating syndrome and multiple sclerosis. Acta Neurol Scand. 2002; 105: 378–383.
  • Referans 24. Roussel V, Yi F, Jauberteau MO, et al. Prevalence and clinical significance of anti-phospholipid antibodies in multiple sclerosis: A study of 89 patients. J Autoimmun. 2000; 14: 259–265.
  • Referans 25. Garg N, Zivadinov R, Ramanathan M, et al. Clinical and MRI correlates of autoreactive antibodies in multiple sclerosis patients. J Neuroimmunol. 2007; 187: 159–165.
  • Referans 26. Maria J Cuadrado, Munther A. Khamashta, Angel Ballesteros, et al. Can Neurologic manifestations of Hughes (Antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literatüre. Medicine. 2000;Vol (79) No.1:57-68.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm OLGU SUNUMLARI / CASE REPORTS
Yazarlar

Gülnur Tekgöl Uzuner 0000-0002-9795-4817

Atilla Özcan Özdemir 0000-0002-9864-6904

Cengiz Korkmaz 0000-0003-2679-0699

Nevzat Uzuner 0000-0002-4961-4332

Yayımlanma Tarihi 19 Temmuz 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

Vancouver Tekgöl Uzuner G, Özdemir AÖ, Korkmaz C, Uzuner N. Anti-Phosholipid Syndrome Misdiagnosed As Multiple Sclerosis: A Case Report. Osmangazi Tıp Dergisi. 2022;44(4):580-6.


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