Ovarian vein thrombosis in the antiphospholipid syndrome

Abstract

Ovarian vein thrombosis (OVT) is an unusual condition mainly observed during the postpartum period. It has not been reported to date in the antiphospholipid syndrome. Two female patients with definite antiphospholipid syndrome, ages 33 years and 73 years, were diagnosed as having OVT by computed tomography (CT) scan, according to the radiologic criteria described by Zerhouni et al. In 1 of the women, the left vein was affected by OVT, while in the other woman, the right vein was affected. One of the patients had a pulmonary embolism; the diagnosis of OVT was established after she underwent a cesarean section and a right atrium thrombectomy. The other patient had no vascular manifestations. OVT was asymptomatic in both patients. Searches for associated thrombophilic states yielded negative results. With the continuation of anticoagulation therapy, the 2 patients have remained in good condition. Resolution of the OVT was observed in the patient who underwent a CT scan during followup. To our knowledge, this is the first report of OVT occurring in the antiphospholipid syndrome. Given that it may develop in the absence of pelvic clinical manifestations, this complication may be underdiagnosed.Ovarian vein thrombosis (OVT) usually occurs in the postpartum period, but can occur less frequently after gynecologic surgery or in the course of pelvic inflammatory disease (1,2). To date, OVT has not been described in the antiphospholipid syndrome (APS). We describe herein 2 female patients with primary APS who developed asymptomatic OVT, which was diagnosed by computed tomography (CT) scan. CASE REPORTSPatient 1. Patient 1, a 33-year-old woman without any history of thrombosis, was, at the time of presentation, in her fourth pregnancy (after 2 births and 1 stillborn). At 33 weeks' gestation, she reported having left chest pain and dyspnea. On admission, her pulse was 90 beats/minute and the jugular vein pressure was raised. The patient had neither fever nor abdominal pain. Right atrial thrombosis was detected on echocardiogram.The patient tested positive for lupus anticoagulant by activated partial thromboplastin time (APTT) (patient 60 seconds versus control 33 seconds, positive mixing). She had high levels (85 IgG phospholipid [GPL] units) of anticardiolipin antibodies (aCL), was positive for IgG anti-␤ 2 -glycoprotein I (␤ 2 GPI) antibodies, and had a false positive result on the VDRL test, but was negative for antinuclear and anti-double-stranded DNA (dsDNA) antibodies. Homocysteinemia was slightly increased. Test results for antithrombin III, protein C and S deficiencies, factor V Leiden, and prothrombin G20210A mutation were negative or normal.After a cesarean section, the patient gave birth to a healthy child. A right atrium thrombectomy was performed soon after, and intravenous heparin (36,000 units/day) was started 6 hours postoperatively, followed by oral anticoagulation on the sixth day. A chest CT scan demonstrated a left-lobe pulmonary embolism, and an abdominopelvic CT scan revealed a left OVT (Figure 1). Find...

Endocrinologic Manifestations of the Antiphospholipid Syndrome

“…48 Testes Testicular thrombosis secondary to APS was described in few case reports in the literature. In 2001 Leder et al described the case of a 24-year old male with acute HIV infection and elevated IgG aCL who developed necrotic lesions on the lower extremities together with testicular thrombosis necessitating orchiectomy.…”

Postpartum Ovarian Vein Thrombosis: An Update

“…Several case reports describe the discovery of a thrombophilia during the evaluation of a patient with OVT. Andre et al report a case of postpartum OVT in a patient with known antiphospholipid antibody syndrome (19), whereas Morales-Rosello et al report a positive lupus anticoagulant test in a workup of a patient for postpartum OVT (14). Salomen et al noted that 11 of 22 patients with a diagnosis of postpartum OVT tested positive for a thrombophilia-4 heterozygotes for FVL, 2 deficient in protein S, one deficient in protein S and heterozygous for FVL, and 4 homozygous for the methylenetetrahydrofolate reductase (MTHFR) mutation (6).…”

Review of Endocrine Manifestations of Antiphospholid Syndrome

“…Two women with APS were reported with ovarian vein thrombosis by CT scan [59]. Idiopathic ovarian vein thrombosis is very rare and usually occurs post-partum.…”