Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome Diagnosed After Pulmonary Thromboembolism in a Male Patient

Abstract

Cem ÖZİŞLERTurkiye Klinikleri J Cardiovasc Sci 2017;29(3):82-5 83 female predominance (female:male ratio, 5:1) was confirmed in APS patients, but this was greater in patients with associated SLE (7:1) than in the primary APS (3.5:1). 5 In this article, I present a male patient with SLE and secondary APS diagnosed after pulmonary thromboembolism. A written informed consent was obtained from the patient. CASE REPORTA 34-year-old male patient admitted to another hospital with a complaint of dyspnea and chest pain. The patient was diagnosed as pulmonary thromboembolism and the lower extremity deep venous thrombosis was detected as an embolism source and anticoagulant treatment was initiated to the patient. The patient was sent to our hospital for rheumatologic evaluation when the antinuclear antibody and anticardiolipin antibodies were detected positive.Approximately four months after the diagnosis of pulmonary thromboembolism, he referred to our rheumatology outpatient clinic. He had no other chronic illness in his medical history and was not using any treatment other than warfarin. There was not any feature in rheumatological questioning except mild arthralgia and short-term morning stiffness in hand joints. Except from mild tenderness in the hand joints, there was no feature in his physical examination. The laboratory tests results of the patient are summarized (Table 1).The patient was diagnosed with SLE according to the SLICC classification criteria because of ANA, anti-dsDNA and antiphospholipid antibodies positivity, hypocomplementemia and thrombocytopenia. 6 In addition, antiphospholipid syndrome was diagnosed according to the Sapporo classification criteria due to deep vein thrombosis and pulmonary thromboembolism, aCL IgG/IgM positivity (4 months ago, aCL IgG and IgM were positive, too).7 Anticoagulant treatment was supplemented with 400 mg/day of hydroxychloroquine and 6 mg/day of methylprednisolone. After 1 month, the patient's joint complaints and morning stiffness had improved, platelet counts, ESR and CRP levels were normal. If the patient continues to be in good clinical condition, our treatment plan is to discontinue methylprednisolone, continue with hydroxychloroquine and warfarin treatment. The treatment was planned according to the EULAR recommendations for the management of SLE. DISCUSSIONSLE is a chronic autoimmune disease with multisystem involvement that can cause life-threatening clinical conditions from time to time. SLE affects women more often than men and it is commonly known as the disease of women of childbearing age. 1,2 In a study, to assess the differences between SLE clinics in men and women; men were more affected than women in terms of disability, hypertension, thrombosis, renal and haematological involvement. Women were more likely to have malar rash, photosensitivity, oral ulcer, alopecia, Raynaud phenomenia and arthralgia. It is also stated that end-organ damage and related deaths such as neuropsychiatric, renal, cardiovascular, peripheral vascular disease and myocardial ...