Download PDF
Semin Thromb Hemost 2012; 38(04): 328-332
DOI: 10.1055/s-0032-1311992
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rarer Clinical Associations of Antiphospholipid Antibodies

David Gillis
1   Immunology Department, Pathology Queensland, Australia
,
Richard C.W. Wong
1   Immunology Department, Pathology Queensland, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
07 May 2012 (online)

   Permissions and Reprints

Abstract

Detection of antiphospholipid antibodies (aPL) are central to the definition of the antiphospholipid (antibody) syndrome (APS). Thrombosis in certain vascular beds, such as the cerebral circulation, the veins of the lower legs and cutaneous vessels, and/or fetal loss, are common manifestations of APS. However, aPL have been found in association with a large range of other clinical conditions—these conditions constitute a rather heterogeneous group and are the subject of this review. Thus, aPL may rarely be found in association with thromboses of vascular beds other than those commonly associated with APS. The combination of thrombosis and aPL still satisfies the criteria for APS, and management of this group of patients is the same as that of APS associated with the more common manifestations of the disease. Alternatively, aPL may be detected in a range of conditions where thrombosis cannot be clearly demonstrated, such as duodenal ulcer or transverse myelopathy. The approach to management of patients who have aPL in association with these conditions is less clear, although in some cases interventions to remove the associated antibody have been associated with amelioration of the condition. Finally, in several studies, aPL have been detected in a proportion of patients with conditions occurring commonly in the normal population—these findings have to be treated with caution in view of inconsistent findings between the reported results and methodological limitation of studies purporting to show positive results.

Keywords

antiphospholipid antibodies - antiphospholipid syndrome - thrombosis - rare associations
 

  • References

  • 1 Asherson RA, Cervera R, Merrill JT, Erkan D. Antiphospholipid antibodies and the antiphospholipid syndrome: clinical significance and treatment. Semin Thromb Hemost 2008; 34: 256-266
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Miyakis S, Lockshin MD, Atsumi T , 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
    CrossrefPubMedSearch in Google Scholar
  • 3 Galli M. Interpretation and recommended testing for antiphospholipid antibodies. Semin Thromb Hemost 2012; 38 (4) 348-352
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Mameli A, Barcellona D, Vannini ML, Marongiu F. High frequency of inadequate test requests for antiphospholipid antibodies in daily clinical practice. Clin Chem Lab Med 2011; 49 (4) 695-698
    CrossrefPubMedSearch in Google Scholar
  • 5 Boltin D, Boguslavski V, Sagi L, Goor Y, Elkayam O. Antiphospholipid syndrome presenting as unilateral renal artery occlusion: case report and literature review. Rheumatol Int 2009; 29 (7) 831-835
    CrossrefPubMedSearch in Google Scholar
  • 6 Tektonidou MG ; Tekhnodou Maria. Renal involvement in the antiphospholipid syndrome (APS)-APS nephropathy. Clin Rev Allergy Immunol 2009; 36 (2–3) 131-140
    CrossrefPubMedSearch in Google Scholar
  • 7 Barak N, Orion Y, Schneider M, Bernheim J, Mekori YA. Case report: hepatic involvement in antiphospholipid syndrome. J Gastroenterol Hepatol 1999; 14 (11) 1124-1128
    CrossrefPubMedSearch in Google Scholar
  • 8 Berkelhammer C, Patel N, Chen J, Sheth S, Stein R, Ambrose S. Hepatic infarction during pregnancy in catastrophic antiphospholipid syndrome. J Gastroenterol Hepatol 2007; 22 (10) 1695-1696
    CrossrefPubMedSearch in Google Scholar
  • 9 Cappell MS. Esophageal necrosis and perforation associated with the anticardiolipin antibody syndrome. Am J Gastroenterol 1994; 89 (8) 1241-1245
    PubMedSearch in Google Scholar
  • 10 Vyas A, Kadikoy H, Haque W, Abdellatif A. Catastrophic antiphospholipid syndrome presenting as ischemic pancreatitis in systemic lupus erythematosus. JOP 2009; 10 (5) 566-569
    PubMedSearch in Google Scholar
  • 11 De-Leon-Bojorge B, Zaltzman-Girsevich S, Ortega-Salgado A, Prieto-Patron A, Córdoba-Córdoba R, Yamazaki-Nakashimada M. Thrombotic microangiopathy involving the gallbladder as an unusual manifestation of systemic lupus erythematosus and antiphospholipid syndrome: case report and review of the literature. World J Gastroenterol 2006; 12 (44) 7206-7209
    PubMedSearch in Google Scholar
  • 12 Erzin Y, Yalin AS, Erdamar AS, Celik AF. Necrosis of small intestine. antiphospholipid syndrome. Neth J Med 2008; 66 (9) 400-401
    PubMedSearch in Google Scholar
  • 13 Takase K, Murai H, Furuya H, Ohyagi Y, Yamada T, Kira J. [An adult case of primary antiphospholipid syndrome presenting recurrent anterior spinal artery syndrome]. Rinsho Shinkeigaku 2001; 41 (2–3) 136-139
    PubMedSearch in Google Scholar
  • 14 Thomas P, Lebrun C, Mahagne MH, Desnuelles C, Chatel M. [Ischemic encephalopathy in primary antiphospholipid syndrome]. Rev Neurol (Paris) 1993; 149 (5) 336-339
    PubMedSearch in Google Scholar
  • 15 Varma PP, Khurana H, Hooda AK, Marwaha V, Badwal S. Renal thrombotic microangiopathy and cerebral venous thrombosis in a young man. Natl Med J India 2007; 20 (6) 297-299
    PubMedSearch in Google Scholar
  • 16 Ford HJ, Roubey RA. Pulmonary manifestations of the antiphospholipid antibody syndrome. Clin Chest Med 2010; 31 (3) 537-545
    CrossrefPubMedSearch in Google Scholar
  • 17 Cervera R, Piette JC, Font J , et al; Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46 (4) 1019-1027
    CrossrefPubMedSearch in Google Scholar
  • 18 Sacré K, Brihaye B, Hyafil F , et al. Asymptomatic myocardial ischemic disease in antiphospholipid syndrome: a controlled cardiac magnetic resonance imaging study. Arthritis Rheum 2010; 62 (7) 2093-2100
    PubMedSearch in Google Scholar
  • 19 Sangle SR, D'Cruz DP. Syndrome X (angina pectoris with normal coronary arteries) and myocardial infarction in patients with anti-phospholipid (Hughes) syndrome. Lupus 2008; 17 (2) 83-85
    CrossrefPubMedSearch in Google Scholar
  • 20 Cianciulli TF, Saccheri MC, Lax JA , et al. Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism. Cardiol J 2009; 16 (6) 560-563
    PubMedSearch in Google Scholar
  • 21 Bayraktar Y, Tanaci N, Egesel T, Gököz A, Balkanci F. Antiphospholipid syndrome presenting as portopulmonary hypertension. J Clin Gastroenterol 2001; 32 (4) 359-361
    CrossrefPubMedSearch in Google Scholar
  • 22 Uthman I, Khamashta M. The abdominal manifestations of the antiphospholipid syndrome. Rheumatology (Oxford) 2007; 46 (11) 1641-1647
    CrossrefPubMedSearch in Google Scholar
  • 23 Cappell MS. Atypical duodenal ulcer associated with the antiphospholipid antibody syndrome. Am J Gastroenterol 1997; 92 (4) 722
    PubMedSearch in Google Scholar
  • 24 Gelosa G, Tremolizzo L, Galbussera A , et al. Narrowing the window for 'senile chorea': a case with primary antiphospholipid syndrome. J Neurol Sci 2009; 284 (1–2) 211-213
    CrossrefPubMedSearch in Google Scholar
  • 25 Tam LS, Cohen MG, Li EK. Hemiballismus in systemic lupus erythematosus: possible association with antiphospholipid antibodies. Lupus 1995; 4 (1) 67-69
    CrossrefPubMedSearch in Google Scholar
  • 26 Chen WH, Chen CJ. Antiphospholipid antibody, head-shaking and ataxia: an evidence of non-vascular neurotoxicity and successful treatment by plasmapheresis. Rheumatol Int 2009; 29 (7) 827-829
    CrossrefPubMedSearch in Google Scholar
  • 27 Suvajac G, Stojanovich L, Milenkovich S. Ocular manifestations in antiphospholipid syndrome. Autoimmun Rev 2007; 6 (6) 409-414
    CrossrefPubMedSearch in Google Scholar
  • 28 Shaharao V, Bartakke S, Muranjan MN, Bavdekar MS, Bavdekar SB, Udani VP. Recurrent acute transverse myelopathy: association with antiphospholipid antibody syndrome. Indian J Pediatr 2004; 71 (6) 559-561
    CrossrefPubMedSearch in Google Scholar
  • 29 Pittock SJ, Lennon VA, de Seze J , et al. Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol 2008; 65 (1) 78-83
    CrossrefPubMedSearch in Google Scholar
  • 30 Starakis I, Mazokopakis E, Siagris D, Liossis S, Karatza C, Antonopoulos A. Catastrophic antiphospholipid syndrome presented with severe hypertension, adult respiratory distress syndrome and unilateral adrenal haemorrhagic infarction. Rheumatol Int 2007; 27 (8) 781-783
    CrossrefPubMedSearch in Google Scholar
  • 31 Kelion AD, Cockcroft JR, Ritter JM. Antiphospholipid syndrome in a patient with rapidly progressive fibrosing alveolitis. Postgrad Med J 1995; 71 (834) 233-235
    CrossrefPubMedSearch in Google Scholar
  • 32 Soltész P, Szekanecz Z, Kiss E, Shoenfeld Y. Cardiac manifestations in antiphospholipid syndrome. Autoimmun Rev 2007; 6 (6) 379-386
    CrossrefPubMedSearch in Google Scholar
  • 33 Tektonidou MG, Malagari K, Vlachoyiannopoulos PG, Kelekis DA, Moutsopoulos HM. Asymptomatic avascular necrosis in patients with primary antiphospholipid syndrome in the absence of corticosteroid use: a prospective study by magnetic resonance imaging. Arthritis Rheum 2003; 48 (3) 732-736
    CrossrefPubMedSearch in Google Scholar
  • 34 Okun MS, Jummani RR, Carney PR. Antiphospholipid- associated recurrent chorea and ballism in a child with cerebral palsy. Pediatr Neurol 2000; 23 (1) 62-63
    CrossrefPubMedSearch in Google Scholar
  • 35 Cimaz R, Meroni PL, Shoenfeld Y. Epilepsy as part of systemic lupus erythematosus and systemic antiphospholipid syndrome (Hughes syndrome). Lupus 2006; 15 (4) 191-197
    CrossrefPubMedSearch in Google Scholar
  • 36 Horstman LL, Jy W, Bidot C , et al. Antiphospholipid antibodies: paradigm in transition. J Neuroinflammation 2009; 6: 3
    CrossrefPubMedSearch in Google Scholar
  • 37 Mosek A, Yust I, Treves TA, Vardinon N, Korczyn AD, Chapman J. Dementia and antiphospholipid antibodies. Dement Geriatr Cogn Disord 2000; 11 (1) 36-38
    CrossrefPubMedSearch in Google Scholar
  • 38 Ranua J, Luoma K, Peltola J , et al. Anticardiolipin and antinuclear antibodies in epilepsy – a population–based cross-sectional study. Epilepsy Res 2004; 58 (1) 13-18
    CrossrefPubMedSearch in Google Scholar
  • 39 Tektonidou MG, Varsou N, Kotoulas G, Antoniou A, Moutsopoulos HM. Cognitive deficits in patients with antiphospholipid syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings. Arch Intern Med 2006; 166 (20) 2278-2284
    CrossrefPubMedSearch in Google Scholar
  • 40 Harrison MJ, Ravdin LD. Cognitive dysfunction in the patient with antiphospholipid antibodies: considerations for cause and treatment. Curr Rheumatol Rep 2006; 8 (2) 89-94
    CrossrefPubMedSearch in Google Scholar