Approach to the primary adrenal insufficiency caused by anti-phospholipid syndrome / 中华内分泌代谢杂志

The causes of primary adrenal insufficiency(PAI) are varying, however, anti-phospholipid syndrome (APS) is a relatively rare one. PAI lacks unique clinical manifestations, so the confirmation of PAI was easily to be neglected by physicians. We report a case with abdominal pain as the first complaint, followed by multiple infections, thrombotic events, and aggravating fatigue. Through a series of the laboratory examination, medical imaging, and pathology examination, this patient was diagnosed as PAI caused by APS. Combining this report with literature review, we aim to raise awareness of the disease and avoid misdiagnosis and missed diagnosis.

Assessment of Antiphospholipid Antibodies, CD4 Count and Some Haematological Parameters in HIV Patients attending a Tertiary Health Institution in South-Western Nigeria

Background: Antiphospholipid antibodies (aPLs) are the serological markers used in the diagnosis of the antiphospholipid syndrome (APS). HIV infection has been associated with an elevated aPls level, but its link to the APS with clinical thrombosis is still been investigated. This study is designed to determine and correlate serum level of antiphospholipid antibodies with CD4 count and some haematological parameters of HIV seropositive subjects in comparison to those of healthy controls and also to compare these parameters between antiretroviral therapy (ART) naïve and treated patients. Methodology: A cohort of 110 patients which consist of 90 HIV positive Patients (22 males and 68 females) and 20 HIV negative patients (10 males and 10 females) which serve as control attending Babcock University Teaching Hospital (BUTH) Ilishan-Remo, Ogun State, Nigeria were recruited for the cross-sectional study. HIV antibodies were detected using 3 rapid diagnostic kits (Determine, Unigold and Stat Pak). CD4+ cells were counted using Partec® Cyflow Counter (Germany). The Full Blood Count was analyzed using the Sysmex® Automated Haematology Analyzer (Kobe-Japan). Antiphospholipid antibodies (aPLs) were assayed using the Human Anti-Phospholipid Screen IgG/IgM ELISA kit (Alpha Diagnostic International, Texas, USA). Results: The present study showed that the mean serum antiphospholipid antibody level was significantly (P<0.001) higher in HIV positive Patients (11.83±7.36u/ml) compared to the control group (7.30±3.95u/ml). While on one hand, there was a strong positive correlation between serum aPLs level and PLT (r= 0.044), MCHC (r= 0.084) and LYM (r= 0.105) in HIV infection; on the other hand, there was a strong negative correlation with CD4 count (r= -0.094), PCV (r= -0.099), Hb (r= -0.072), RBC (r= -0.003), WBC (r= -0.063), MNO (r= -0.213), GRA (r= -0.003), MCV (r= -0.023) and MCH (r= -0.005). Also, there was no significant differences (P>0.05) between the aPLs level of HIV group on ART (11.44±7.74 u/ml) and those not on ART (12.00±7.24 u/ml). Some haematological parameters like PLT, PCV, Hb, RBC and red cell indices of the HIV group on ART did not differ significantly from those not on ART. However, the CD4 count (638.89±119.56 cell/?L), WBC (5.38±1.49X103/?L), LYM (51.43±7.99%) and GRA (46.30±10.18%) of the HIV group on ART were significant higher than those not on ART (465.30±145.92 cell/?L, 4.55±1.57X103/?L, 42.23±10.96% and 39.10±7.81%, respectively). Conclusion: Significant elevated aPLs level is present in HIV infection; however, the information obtained is not sufficient to indicate the occurrence of anti-phospholipid syndrome in HIV infection. There was no strong relationship between aPLs level and indicators of immunohaematological abnormalities in HIV infection. This finding is plausible and would therefore require further investigation.

Childhood Lupus with Microangiopathic Antiphospholipid Syndrome and Pulmonary Hemorrhage.

Background: Concurrent thrombotic and hemorrhagic manifestations are uncommon in patients with Antiphospholipid Syndrome. Case characteristics: A 10-year-old girl with fever, edema, rash and joint pains, who later developed deep venous thrombosis (DVT), stroke, thrombotic microangiopathic hemolytic anemia and pulmonary hemorrhage. Investigations confirmed Antiphospholipid syndrome associated with systemic lupus erythematosus. Outcome: She went into complete remission with intravenous immunoglobulins, plasmapheresis, immunosuppression and anticoagulation. Message: Thrombotic microangiopathic hemolytic anemia and anti-phospholipid syndrome can be the presenting manifestations of systemic lupus erythematosus..

A Case of Primary Anti-Phospholipid Syndrome with Recurrent Renal Infarction / 대한내과학회지

Anti-phospholipid syndrome is characterized by the occurrence of venous or arterial thrombosis in the presence of anti-phospholipid antibodies and is associated with morbidity during pregnancy. Arterial thromboses are less common than venous thromboses and most frequently manifest with features consistent with ischemia or infarction. Only a few cases of arterial thrombosis with primary anti-phospholipid syndrome have been reported in Korea. We report a 41-year-old man with anti-phospholipid syndrome who had abdominal pain due to a recurrent renal infarction, and we review the literature on anti-phospholipid syndrome.