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JOURNAL OF CLINICAL MEDICINE OF KAZAKHSTAN 2014 VOLUME 2, NUMBER 32
РЕДАКТОРГА ХАТ / ПИСЬМО РЕДАКТОРУ / LETTER TO EDITOR
УДК: 616-002.77
Материал поступил в редакцию: 25-07-2014 Материал принят к печати: 30-07-2014
A male patient with systemic lupus erythematosis and antiphospholipid syndrome presented with deep venous thrombosis
Kucuk A.1, Albayrak I.2, Basturk A.3, Arslan S.4
department of Rheumatology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey 2Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey. 3Department of Hematology, Konya Education and Research Hospital, Konya, Turkey
4Department of Immunology and Allergy, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
Systemic lupus erythematosis (SLE) is a chronic disease. Antiphospholipid antibodies are detected in laboratuary; and recurrent thrombosis or pregnancy morbidity may be seen in clinic. We presented a man who diagnosed SLE and Antiphospholipid syndrome when investigated because of deep venous thrombosis.
Key words: systemic lupus erythematosis, antiphospholipid syndrome, deep venous thrombosis.
J Clin Med Kaz 2014; 2(32): 76-77
Corresponding Author: Ilknur Albayrak, Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey, Phone: +90 505 689 97 50, Fax number: +90 332 241 60 65, e-mail: ilknurftr@gmail.com
АНТИФОСФОЛИПИДТ1 СИНДРОМ МЕН ЖУЙЕЛ1 КЫЗЫЛ ЖЕГ1 КЕЗ1НДЕГ1 ТЕРЕЦ КОКТАМЫРЛАРДЫЦ ТРОМБОЗЫ КЕЗ-ДЕСКЕН КЛИНИКАЛЬЩ ЖАГДАЙ Kucuk A.1, Albayrak I.2, Basturk A.3, Arslan S.4
^екметтин Эрбакан университетшщ медициналык факультетшщ ревматология белЛмЛ, Кония, Туркия
2Сельчук университетшщ медициналык факультетшщ физикалык мендицина мен калпына келттру белЛмЛ, Кония, Туркия.
3Кония оку мен зерттеу ауруханасыньщ гематология белЛмЛ, Кония, Туркия
4Некметтин Эрбакан университетшщ медициналык факультетшщ иммунология мен аллергология белЛмЛ, Кония, Туркия
ЖYЙелі кызыл жеп (ЖКЖ) созылмалы ауру болап табылады. Эдетте клиникалык тэжірибеде жYЙелі кызыл жеп мен антифосфолипидт синдром жуктшж кезшдеп патологияда кездеседь Біз антифосфолипидт синдромы бар жYЙелі кызыл жепмен ауыратын ер адамныц клиникалык жагдайын ^сынып отырмын. Тексершу кезінде терец кектамырларыныц тромбозы аныкталган.
Манызды сездер: жYЙелі кызыл жеп, антифосфолипидт! синдром, терец кектамырлардыц тромбозы.
СЛУЧАЙ СИСТЕМНОЙ КРАСНОЙ ВОЛЧАНКИ С АНТИФОСФОЛИПИДНЫМ СИНДРОМОМ В СОЧЕТАНИИ С ТРОМБОЗОМ ГЛУБОКИХ ВЕН
Kucuk A.1, Albayrak I.2, Basturk A.3, Arslan S.4
Ютдел ревматологии, Медицинский факультет университета Некметтин Эрбакан, Конья, Турция
2Отдел физической медицины и реабилитации, медицинский факультет университета Сельчук, Конья, Турция.
3Отдел гематологии, Госпиталь образования и исследований, Конья, Турция
4Отдел иммунологии и аллергологии, Медицинский факультет университета Некметтин Эрбакан, Конья, Турция
Системная красная волчанка (СКВ) является хроническим заболеванием. В клинической практике антифосфолипидный синдром и рецидивирующий тромбоз обычно встречаются при патологии беременных. Мы представили клинический случай у мужчины, у которого был выставлен диагноз СКВ с антифосфолипидным синдромом. При обследований выявлен тромбоз глубоких вен.
Ключевые слова: системная красная волчанка, антифосфолипидный синдром, тромбоз глубоких вен.
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НАУЧНО-ПРАКТИЧЕСКИЙ МЕДИЦИНСКИЙ ЖУРНАЛ
INTRODUCTION
Systemic lupus erythematosis (SLE) is a chronic disease. It is most commonly seen in women of childbearing age. Therefore, hormonal factors are thought to play a role in the pathogenesis. Male and female ratio is about 4.3 to 11.7 according to different studies [1]. Antiphospholipid syndrome (AFS) is seen in
one of three SLE patients. Antiphospholipid antibodies are detected in laboratuary; and recurrent thrombosis or pregnancy morbidity may be seen in clinic [1]. We presented a 36 year old man who diagnosed SLE and AFS when investigated because of deep venous thrombosis (DVT).
CASE
A 36 year old man admitted with complaints of fatigue and arthralgia. Malar rash, photosensitivity and arthritis were not present. He has had DVT 5 months ago and he has been using anticoagulant treatment. In physical examination there is no pathological sign. His arterial tension was 110/60 mmHg. In laboratory, sedimentation was 29 mm / h, C-reactive protein 10 mg / L, WBC 3.9 x 103, Hgb 13.5 g / dL, PLT 240 x103, Crea 0.8 mg / dL, ALT 19 U/L,C3 0.5 (0.7-1.52), C4 0.07 g / L and TSH 3 pi/ml. Urine analysis was normal. In antibody profile: ANA was stained as homogen(+++) and granular (+) pattern. Anti-dsDNA, anti-SSA, anti-SSB, Ro52 and PM-
Scl were positive. INR was 1.8 and aPTT was 38.1 second. Lipid panel and 24-hour urine protein were within normal limits. Finally anticardiolipin (AKA) and antiphospholipid (AFA) antibodies were positive so diagnosis of SLE and AFS were performed. As a treatment: hydroxychloroquine 200 mg 2x1, azathioprine 50 mg 3x1, acetylsalicylic acid, warfarin and steroids were started. After a period hydroxychloroquine was decreased to 200 mg 1x1 and steroid was discontinued. He has been followed for 3 years successfully and he has got no complaint now. In this follow up period his brother was diagnosed SLE and treated.
DISCUSSION
AFS is called primer AFS when found isolated disease and seconder AFS when found with SLE, Sjogren’s syndrome or another rheumatic diseases. Some clinical findings may be associated with AFS such as thrombocytopenia, hemolytic anemia, heart valve disease, livedo reticularis and neurological abnormalities [1]. In addition, venous and arterial thrombosis are also observed in AFS; most commonly DVT and pulmonary embolism are determined. AFAs are responsible in the pathogenesis of AFS but secondary factors are also required for the development.
These factors include smoking, immobilization, pregnancy, oral contraceptive use, malignancies, hypertension, and hyperlipidemia. Male gender and presented with DVT are remarkable points of our SLE patient [2]. It is keep in mind that SLE, which is seen mostly in females, may show atypical presentation signs. In conclusion while investigating the etiology of DVT, AFS should be ruled out, even if clinical findings were not present.
There is no conflicts of interests
REFERENCES
1. Radic M, Herrmann M, van der Vlag J, et al. Regulatory and pathogenic mechanisms of autoantibodies in SLE // Autoimmunity. 2011.-Vol.44.-P. 349-356.
2. Tsokos GC. Systemic lupus erythematosus // N Engl J Med. 2011.-Vol.365.-P.2110-2121.
SCIENTIFIC-PRACTICAL MEDICAL JOURNAL
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JOURNAL OF CLINICAL MEDICINE OF KAZAKHSTAN 2014 VOLUME 2, NUMBER 32
