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Bilişsel Fonksiyon Bozukluğuyla Başvuran Primer Antifosfolipid Antikor Sendromu Olgusu

Yıl 2024, Cilt: 46 Sayı: 6, 990 - 995, 07.11.2024
https://doi.org/10.20515/otd.1494475

Öz

Antifosfolipid antikor sendromu antifosfolipid antikorları ile ilişkili tekrarlayan arteryel, venöz ve mikrovasküler trombozlar, tekrarlayan erken gebelik kaybı, fetal kayıp ve gebelik komplikasyonlarıyla karakterize sistemik bir otoimmün bozukluktur. Ayrıca deri ülserasyonları, bilişsel fonksiyonlarda kötüleşme, trombositopeni, hemolitik anemi, kalp kapağı hastalığı ve nefropati sık eşlik edebilen klinik bulgulardır. Altta yatan bir hastalık ve ilaç kullanımı yoksa primer antifosfolipid sendromu olarak kabul edilir. Sistemik lupus eritematozus başta olmak üzere eşlik eden otoimmün bir hastalık, ilaç kullanımı ya da başka bir hastalık varsa sekonder antifosfolipid sendromu olarak kabul edilir. Polikliniğe bilişsel fonksiyonlarda bozulma, bacaklarda şişlik ve ağrı yakınmalarıyla başvuran hastada bilateral alt extremitelerde venöz trombozlar, pulmoner emboli ve kronik serebrovasküler iskemik olaylar tespit edildi. Etyolojiye yönelik yapılan ileri tetkiklerde hastada primer antifosfolipid sendromu saptandı. Bu olgu sunumuyla farklı klinik durumlarla karşımıza çıkabilen primer antifosfolipid antikor sendromu tartışıldı.

Etik Beyan

Olgu sunumu için hastadan onam alınmıştır.

Kaynakça

  • 1. Cervera R. Antiphospholipid syndrome. Thromb Res. 2017;151 Suppl 1:43-7.
  • 2. Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N,et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019;78(10):1296-304
  • 3. Durcan L, Petri M(Edited by). "Epidemiology of the antiphospholipid syndrome." Handbook of systemic autoimmune diseases. Vol. 12. Elsevier, 2017. 17-30
  • 4. Sciascia S, Amigo MC, Roccatello D, Khamashta M. Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances. Nat Rev Rheumatol. 2017;13(9):548-60.
  • 5. Ricarte IF, Dutra LA, Abrantes FF, Toso FF, Barsottini OGP, Silva GS, et al. Neurologic manifestations of antiphospholipid syndrome. Lupus. 2018;27(9):1404-414.
  • 6. Hughes GR. Systemic lupus erythematosus. Postgrad Med J. 1988;64(753):517-21.
  • 7. Amiral J, Peyrafitte M, Dunois C, Vissac AM, Seghatchian J. Anti-phospholipid syndrome: Current opinion on mechanisms involved, laboratory characterization and diagnostic aspects. Transfus Apher Sci. 2017;56(4):612-25.
  • 8. 8.Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306.
  • 9. Keeling D, Mackie I, Moore GW, Greer IA, Greaves M; British Committee for Standards in Haematology. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol. 2012;157(1):47-58.
  • 10. Lim W. Antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program. 2013;2013:675-80.
  • 11. de Groot PG, Meijers JC. β(2) -Glycoprotein I: evolution, structure and function. J Thromb Haemost. 2011;9(7):1275-84.
  • 12. Atsumi T, Khamashta MA, Amengual O, Donohoe S, Mackie I, Ichikawa K,et al. Binding of anticardiolipin antibodies to protein C via beta2-glycoprotein I (beta2-GPI): a possible mechanism in the inhibitory effect of antiphospholipid antibodies on the protein C system. Clin Exp Immunol. 1998;112(2):325-33.
  • 13. Knight JS, Kanthi Y. Mechanisms of immunothrombosis and vasculopathy in antiphospholipid syndrome. Semin Immunopathol. 2022;44(3):347-62.
  • 14. Chaturvedi S, Brodsky RA, McCrae KR. Complement in the Pathophysiology of the Antiphospholipid Syndrome. Front Immunol. 2019,14;10:449.
  • 15. Girardi G, Redecha P, Salmon JE. Heparin prevents antiphospholipid antibody-induced fetal loss by inhibiting complement activation. Nat Med. 2004;10(11):1222-6.
  • 16. Cervera R. Antiphospholipid syndrome. Thromb Res. 2017;151 Suppl 1:43-7.
  • 17. Abe N, Atsumi T. Neurological Manifestations in Antiphospholipid Syndrome. Brain Nerve. 2021;73(5):526-36.
  • 18. Ricarte IF, Dutra LA, Abrantes FF, Toso FF, Barsottini OGP, Silva GS, et al. Neurologic manifestations of antiphospholipid syndrome. Lupus. 2018;27(9):1404-14.
  • 19. Galli M. Which antiphospholipid antibodies should be measured in the antiphospholipid syndrome? Haemostasis. 2000;30 Suppl 2:57-62.
  • 20. Knight JS, Branch DW, Ortel TL. Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management. BMJ. 2023.27;380.
  • 21. Pengo V, Denas G, Zoppellaro G, Jose SP, Hoxha A, Ruffatti A, et al.Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018.27;132(13):1365-71.
  • 22. Woller SC, Stevens SM, Kaplan D, Wang TF, Branch DW, Groat D, et al. Apixaban compared with warfarin to prevent thrombosis in thrombotic antiphospholipid syndrome: a randomized trial. Blood Adv. 2022.22;6(6):1661-70.
  • 23. Mormile I, Granata F, Punziano A, de Paulis A, Rossi FW. Immunosuppressive Treatment in Antiphospholipid Syndrome: Is It Worth It? Biomedicines. 2021.1;9(2):132.
  • 24. Berman H, Rodríguez-Pintó I, Cervera R, Morel N, Costedoat-Chalumeau N, Erkan D, et al. Catastrophic Antiphospholipid Syndrome (CAPS) Registry Project Group (European Forum on Antiphospholipid Antibodies). Rituximab use in the catastrophic antiphospholipid syndrome: descriptive analysis of the CAPS registry patients receiving rituximab. Autoimmun Rev. 2013;12(11):1085-90.
  • 25. D'Ippolito S, Barbaro G, Paciullo C, Tersigni C, Scambia G, Di Simone N. Antiphospholipid Syndrome in Pregnancy: New and Old Pathogenetic Mechanisms. Int J Mol Sci. 2023. 6;24(4):3195.

A Case of Primary Antiphospholipid Antibody Syndrome Presenting with Cognitive Dysfunction

Yıl 2024, Cilt: 46 Sayı: 6, 990 - 995, 07.11.2024
https://doi.org/10.20515/otd.1494475

Öz

Antiphospholipid antibody syndrome is a systemic autoimmune disorder characterized by recurrent arterial, venous, and microvascular thromboses, recurrent early pregnancy loss, fetal loss, and pregnancy complications associated with antiphospholipid antibodies. Additionally, it is often accompanied by clinical manifestations such as skin ulcerations, cognitive decline, thrombocytopenia, hemolytic anemia, heart valve disease, and nephropathy. In the absence of an underlying disease or medication use, it is considered primary antiphospholipid syndrome. If there is an associated autoimmune disease, such as systemic lupus erythematosus, medication use or another underlying condition, it is considered secondary antiphospholipid syndrome. A patient presenting to the clinic with complaints of leg swelling and pain, as well as cognitive dysfunction, was found to have bilateral lower extremity venous thromboses, pulmonary embolism and chronic cerebrovascular ischemic events. Advanced investigations to determine the etiology revealed a diagnosis of primary antiphospholipid syndrome. Various clinical manifestations of primary antiphospholipid antibody syndrome are discussed in this case report.

Kaynakça

  • 1. Cervera R. Antiphospholipid syndrome. Thromb Res. 2017;151 Suppl 1:43-7.
  • 2. Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N,et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019;78(10):1296-304
  • 3. Durcan L, Petri M(Edited by). "Epidemiology of the antiphospholipid syndrome." Handbook of systemic autoimmune diseases. Vol. 12. Elsevier, 2017. 17-30
  • 4. Sciascia S, Amigo MC, Roccatello D, Khamashta M. Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances. Nat Rev Rheumatol. 2017;13(9):548-60.
  • 5. Ricarte IF, Dutra LA, Abrantes FF, Toso FF, Barsottini OGP, Silva GS, et al. Neurologic manifestations of antiphospholipid syndrome. Lupus. 2018;27(9):1404-414.
  • 6. Hughes GR. Systemic lupus erythematosus. Postgrad Med J. 1988;64(753):517-21.
  • 7. Amiral J, Peyrafitte M, Dunois C, Vissac AM, Seghatchian J. Anti-phospholipid syndrome: Current opinion on mechanisms involved, laboratory characterization and diagnostic aspects. Transfus Apher Sci. 2017;56(4):612-25.
  • 8. 8.Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306.
  • 9. Keeling D, Mackie I, Moore GW, Greer IA, Greaves M; British Committee for Standards in Haematology. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol. 2012;157(1):47-58.
  • 10. Lim W. Antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program. 2013;2013:675-80.
  • 11. de Groot PG, Meijers JC. β(2) -Glycoprotein I: evolution, structure and function. J Thromb Haemost. 2011;9(7):1275-84.
  • 12. Atsumi T, Khamashta MA, Amengual O, Donohoe S, Mackie I, Ichikawa K,et al. Binding of anticardiolipin antibodies to protein C via beta2-glycoprotein I (beta2-GPI): a possible mechanism in the inhibitory effect of antiphospholipid antibodies on the protein C system. Clin Exp Immunol. 1998;112(2):325-33.
  • 13. Knight JS, Kanthi Y. Mechanisms of immunothrombosis and vasculopathy in antiphospholipid syndrome. Semin Immunopathol. 2022;44(3):347-62.
  • 14. Chaturvedi S, Brodsky RA, McCrae KR. Complement in the Pathophysiology of the Antiphospholipid Syndrome. Front Immunol. 2019,14;10:449.
  • 15. Girardi G, Redecha P, Salmon JE. Heparin prevents antiphospholipid antibody-induced fetal loss by inhibiting complement activation. Nat Med. 2004;10(11):1222-6.
  • 16. Cervera R. Antiphospholipid syndrome. Thromb Res. 2017;151 Suppl 1:43-7.
  • 17. Abe N, Atsumi T. Neurological Manifestations in Antiphospholipid Syndrome. Brain Nerve. 2021;73(5):526-36.
  • 18. Ricarte IF, Dutra LA, Abrantes FF, Toso FF, Barsottini OGP, Silva GS, et al. Neurologic manifestations of antiphospholipid syndrome. Lupus. 2018;27(9):1404-14.
  • 19. Galli M. Which antiphospholipid antibodies should be measured in the antiphospholipid syndrome? Haemostasis. 2000;30 Suppl 2:57-62.
  • 20. Knight JS, Branch DW, Ortel TL. Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management. BMJ. 2023.27;380.
  • 21. Pengo V, Denas G, Zoppellaro G, Jose SP, Hoxha A, Ruffatti A, et al.Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018.27;132(13):1365-71.
  • 22. Woller SC, Stevens SM, Kaplan D, Wang TF, Branch DW, Groat D, et al. Apixaban compared with warfarin to prevent thrombosis in thrombotic antiphospholipid syndrome: a randomized trial. Blood Adv. 2022.22;6(6):1661-70.
  • 23. Mormile I, Granata F, Punziano A, de Paulis A, Rossi FW. Immunosuppressive Treatment in Antiphospholipid Syndrome: Is It Worth It? Biomedicines. 2021.1;9(2):132.
  • 24. Berman H, Rodríguez-Pintó I, Cervera R, Morel N, Costedoat-Chalumeau N, Erkan D, et al. Catastrophic Antiphospholipid Syndrome (CAPS) Registry Project Group (European Forum on Antiphospholipid Antibodies). Rituximab use in the catastrophic antiphospholipid syndrome: descriptive analysis of the CAPS registry patients receiving rituximab. Autoimmun Rev. 2013;12(11):1085-90.
  • 25. D'Ippolito S, Barbaro G, Paciullo C, Tersigni C, Scambia G, Di Simone N. Antiphospholipid Syndrome in Pregnancy: New and Old Pathogenetic Mechanisms. Int J Mol Sci. 2023. 6;24(4):3195.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm OLGU SUNUMLARI / CASE REPORTS
Yazarlar

Rıfat Bozkuş 0000-0003-1179-0653

Şeyma Sarışen 0009-0006-9096-2714

Yayımlanma Tarihi 7 Kasım 2024
Gönderilme Tarihi 2 Haziran 2024
Kabul Tarihi 5 Ağustos 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 46 Sayı: 6

Kaynak Göster

Vancouver Bozkuş R, Sarışen Ş. Bilişsel Fonksiyon Bozukluğuyla Başvuran Primer Antifosfolipid Antikor Sendromu Olgusu. Osmangazi Tıp Dergisi. 2024;46(6):990-5.


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