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A 37‐Year‐Old Man With Primary Antiphospholipid Syndrome Presenting With Respiratory Distress and Worsening Toe Ischemia
Author(s) -
Kazzaz Nayef M.,
Wilson Allecia M.,
Kado Ruba,
Barnes Geoffrey D.,
Knight Jason S.
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23168
Subject(s) - medicine , respiratory distress , antiphospholipid syndrome , ischemia , distress , cardiology , pediatrics , anesthesia , thrombosis , clinical psychology
History of the present illness This is a 37-year-old man with a history of primary antiphospholipid syndrome (APS), with clinical manifestations including recurrent venous thrombosis, lower-extremity ulceration, and toe ischemia. He also had history of thrombocytopenia and seizure disorder. Laboratory findings were consistent with APS, including prolonged dilute Russell’s viper venom time (dRVVT), as well as an abnormal hexagonal phase phospholipid neutralization assay. He also had high levels of both IgG anticardiolipin and IgG anti–b2glycoprotein I (anti-b2GPI; both consistently .40 units). All of these laboratory findings were durably positive over many years. The patient presented with a 3-day history of dyspnea on exertion, now occurring at rest on the day of presentation. He denied productive cough, hemoptysis, chest pain, nausea, vomiting, abdominal pain, change in bowel habits, or dysuria. He also denied arthralgia, photosensitivity, Raynaud’s phenomenon, ocular symptoms, mucosal ulceration, alopecia, pleurisy, rash, weakness, or paresthesia. He did report worsening bilateral foot pain for about 1 month prior to presentation, with the pain especially severe on the right. He denied typical symptoms of claudication. For 2 days prior to admission, the pain had been especially severe: present at rest, dull in nature, and nonradiating.