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Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report

BACKGROUND: Antiphospholipid syndrome is an autoimmune disorder characterized by the presence of antiphospholipid antibodies and commonly presents with vascular thromboembolic phenomena, thrombocytopenia, and obstetric complications. Antiphospholipid syndrome can be classified as either primary or s...

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Autores principales: Sharma, Yogesh, Humphreys, Karen, Thompson, Campbell
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090673/
https://www.ncbi.nlm.nih.gov/pubmed/30103822
http://dx.doi.org/10.1186/s13256-018-1753-5
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author Sharma, Yogesh
Humphreys, Karen
Thompson, Campbell
author_facet Sharma, Yogesh
Humphreys, Karen
Thompson, Campbell
author_sort Sharma, Yogesh
collection PubMed
description BACKGROUND: Antiphospholipid syndrome is an autoimmune disorder characterized by the presence of antiphospholipid antibodies and commonly presents with vascular thromboembolic phenomena, thrombocytopenia, and obstetric complications. Antiphospholipid syndrome can be classified as either primary or secondary to other connective tissue diseases. Dermatologic manifestations are common; however, non-vasculitic skin ulceration is an uncommon manifestation of antiphospholipid syndrome with limited treatment options. CASE PRESENTATION: In this paper we report the case of a 58-year-old white woman who developed necrotic abdominal wall ulcers 27 years after a diagnosis of secondary antiphospholipid syndrome associated with systemic lupus erythematosus. The ulcers developed despite our patient being on therapeutic anticoagulation with warfarin and were resistant to further increases in the intensity of anticoagulation. Management was further complicated due to reluctance on the part of our patient to switch over to injectable heparin. CONCLUSIONS: This case highlights a rare late dermatologic presentation of antiphospholipid syndrome, which responded poorly to conventional anticoagulation with warfarin. Current management is limited to experimental therapies and the role of newer anticoagulants is still unknown.
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spelling pubmed-60906732018-08-17 Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report Sharma, Yogesh Humphreys, Karen Thompson, Campbell J Med Case Rep Case Report BACKGROUND: Antiphospholipid syndrome is an autoimmune disorder characterized by the presence of antiphospholipid antibodies and commonly presents with vascular thromboembolic phenomena, thrombocytopenia, and obstetric complications. Antiphospholipid syndrome can be classified as either primary or secondary to other connective tissue diseases. Dermatologic manifestations are common; however, non-vasculitic skin ulceration is an uncommon manifestation of antiphospholipid syndrome with limited treatment options. CASE PRESENTATION: In this paper we report the case of a 58-year-old white woman who developed necrotic abdominal wall ulcers 27 years after a diagnosis of secondary antiphospholipid syndrome associated with systemic lupus erythematosus. The ulcers developed despite our patient being on therapeutic anticoagulation with warfarin and were resistant to further increases in the intensity of anticoagulation. Management was further complicated due to reluctance on the part of our patient to switch over to injectable heparin. CONCLUSIONS: This case highlights a rare late dermatologic presentation of antiphospholipid syndrome, which responded poorly to conventional anticoagulation with warfarin. Current management is limited to experimental therapies and the role of newer anticoagulants is still unknown. BioMed Central 2018-08-14 /pmc/articles/PMC6090673/ /pubmed/30103822 http://dx.doi.org/10.1186/s13256-018-1753-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Sharma, Yogesh
Humphreys, Karen
Thompson, Campbell
Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
title Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
title_full Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
title_fullStr Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
title_full_unstemmed Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
title_short Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
title_sort extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090673/
https://www.ncbi.nlm.nih.gov/pubmed/30103822
http://dx.doi.org/10.1186/s13256-018-1753-5
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