Anticardiolipin Antibodies Presenting With Acute Renal Infarction in a Healthy 26-Year-Old Female

A 26-year-old female presented to the emergency department with right lower quadrant pain. This pain lasted a couple of days, worsened, and was associated with nausea but no vomiting. Upon presentation, physical examination showed tenderness to palpation in the right lower quadrant with bilateral purple non-blanching discolorations present on her toes and no costovertebral angle tenderness. Contrast-enhanced computed tomography (CT) showed acute right renal infarction. Thrombophilia workup was done, which showed elevated antinuclear antibodies and anticardiolipin antibodies. Elevated lactate dehydrogenase, c-reactive protein, and sedimentation rate were also found. No other inherited thrombophilia was discovered in lab work. Combined oral contraceptives were stopped, and the patient was started on enoxaparin followed by rivaroxaban upon discharge. The antiphospholipid syndrome commonly presents in young females as recurrent miscarriages, stroke, or deep venous thrombosis. Venous thrombosis is more common than arterial. Rare arterial thrombosis manifestations of this syndrome include coronary, retinal, mesenteric, and renal. This is a rare case of anticardiolipin antibodies presenting as an acute right renal infarction. This raises the question if clinicians should screen for inherited thrombophilia before prescribing oral contraceptives.