Recurrent arterial and venous thrombosis in a 16-year-old boy in the course of primary antiphospholipid syndrome despite treatment with low-molecular-weight heparin: a case report

Abstract

Introduction: Antiphospholipid syndrome is a multisystem autoimmune disease characterized by arterial and/or venous thrombosis and persistent presence of antiphospholipid antibodies. It can be a primary disease or secondary when associated with other autoimmune diseases.

Case presentation: We present a case of a 16-year-old Caucasian boy with a massive arterial and venous thrombosis in his lower limbs as well as in his central nervous system with clinical symptoms such as headaches and chorea. He did not present any clinical or laboratory signs of a systemic inflammatory connective tissue disease, including systemic lupus erythematosus. Based on the clinical picture and results of the diagnostic tests (positive antibodies against β2-glycoprotein and a high titre of anticardiolipin antibodies) we finally diagnosed primary antiphospholipid syndrome. During a 9-month follow up after the acute phase of the disease, he was treated with low-molecular-weight heparin. Neurological symptoms were relieved. Features of recanalization in the vessels of his lower limbs were observed. After a subsequent 6 months, because of the failure of preventive treatment - an incident of thrombosis of the vessels of his testis - treatment was modified and heparin was replaced with warfarin.

Conclusion: Although the preventive treatment with warfarin in our patient has continued for 1 year of follow up without new symptoms, further observation is needed.

Figure 1

Thrombosis of the left femoral vein.

Figure 2

Thrombi in the lumen of the left femoral vein.