DOI: http://dx.doi.org/10.18203/2349-3933.ijam20172284

Avascular necrosis of bone with hemiparesis: a rare presentation of primary antiphospholipid antibody syndrome

Sudhir Bhandari, Vishal Gupta, Kushan Sengupta, Jaswant Goyal, Uttam Kumar

Abstract


Vascular complications are well known manifestations of primary antiphospholipid antibody syndrome but the concurrent existence of avascular necrosis of bone and stroke due to vasculitic infarct is a very rare presentation. We report a case of a middle-aged man who presented with right knee pain and left hemiparesis and was subsequently diagnosed to have primary antiphospholipid antibody syndrome.


Keywords


Avascular necrosis of bone, Primary antiphospholipid antibody syndrome

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References


Hughes G. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. Br Med J Clin Res Ed. 1983;287:1088.

Uthman I, Noureldine M, Berjawi A. Hughes syndrome and Multiple sclerosis. Lupus. 2015;24:115-21.

Rand JH. Molecular pathogenesis of the antiphospholipid syndrome. Circ Res. 2002;90:29-37.

Giannakopoulos B, Passam F, Rahgozar S, Krilis SA. Current concepts on the pathogenesis of the antiphospholipid syndrome. Blood. 2007;109:422-30.

Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arth Rheum. 2002;46:1019-27.

Liote F, Meyer O, Osteoarticular manifestations in the antiphospholipid syndrome. In: Asherson RA, Cervera R, Piette JC, Shoenfeld Y, eds. The Antiphospholipid Syndrome. Boca Raton: CRC Press; 1996:195-200.

Asherson RA, Liote F, Page B, Meyer O, Buchanan N, Khamashta MA, et al. Avascular necrosis of bone and antiphospholipid antibodies in systemic lupus erythematosus. J Rheumatol. 1993;20:284-8.

Nagasawa K, Ishii Y, Mayumi T, Tada Y, Ueda A, Yamauchi Y, et al. Avascular necrosis of bone in systemic lupus erythematosus possible role of haemostatic abnormalities. Ann Rheum Dis. 1989;48:672-6.

Shah NM, Khamashta MA, Atsumi T, Hughes GR. Outcome of patients with anticardiolipin antibodies: a 10 year follow-up of 52 patients. Lupus. 1998;7:3-6.

Levine SR, Salowich-Palm L, Sawaya KL, Perry M, Spencer HJ, Winkler HJ, et al. IgG anticardiolipin antibody titer >40 GPL and the risk of subsequent thrombo-occlusive events and death. A prospective cohort study. Stroke. 1997;28:1660-5.

Provenzale JM, Barboriak DP, Allen NB, Ortel TL. Patients with antiphospholipid antibodies: CT and MR findings of the brain. AJR Am J Roentgenol. 1996;167:1573-8.

Cuadrado MJ, Khamashta MA, Ballesteros A, Godfrey T, Simon MJ, Hughes GR. Can neurologic manifestations of Hughes (antiphospholipid) syndrome be distinguished from multiple sclerosis? Analysis of 27 patients and review of the literature. Medicine (Baltimore). 2000;79:57-68.

Levine SR, Brey RL, Sawaya KL, Salowich-Palm L, Kokkinos J, Kostrzema B, et al. Recurrent stroke and thrombo-occlusive events in the antiphospholipid syndrome. Ann Neurol. 1995;38:119-24.