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Case Reports
. 2018 May 15;57(10):1439-1444.
doi: 10.2169/internalmedicine.9820-17. Epub 2017 Dec 27.

Bilateral Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome during Chronic Graft-versus-host Disease

Mariko Minami  1   2 , Tsuyoshi Muta  1 , Masahiro Adachi  3 , Masakazu Higuchi  4 , Kenichi Aoki  1 , Ryosuke Ogawa  1
Affiliations
Case Reports

Bilateral Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome during Chronic Graft-versus-host Disease

Mariko Minami et al. Intern Med. .

Abstract

We present the case of a 56-year-old man with an upper respiratory infection followed by fatigue, hypotension, and hyponatremia. Bilateral adrenal hemorrhage was confirmed, based on T2-weighted magnetic resonance imaging. The patient had previously undergone allogeneic hematopoietic stem cell transplantation and had been diagnosed with antiphospholipid syndrome (APS) during the development of chronic graft-versus-host disease. A prompt diagnosis and steroid replacement, in addition to anticoagulant therapy, resulted in a favorable outcome. Once the diagnosis of APS has been confirmed, which might be the sign of bilateral adrenal hemorrhage, the initial manifestations of adrenal insufficiency should never be overlooked.

Keywords: adrenal hemorrhage; antiphospholipid antibody syndrome; graft-versus-host disease.

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Figures

Figure 1.
Figure 1.
The clinical course after allogeneic hematopoietic stem cell transplantation (HSCT). GVHD: graft-versus-host disease, CMV: cytomegalovirus, CsA: cyclosporine A, PSL: prednisolone, DVT: deep vein thrombosis, aPTT: activated partial thromboplastin time
Figure 2.
Figure 2.
(A) A central pulmonary embolism was confirmed by computed tomography. (B) Femoral vein thrombosis was also confirmed.
Figure 3.
Figure 3.
The clinical course during the episode of adrenal hemorrhage in 2015. The day of presentation due to upper respiratory infectious symptoms was arbitrarily defined as Day 1. CT: computed tomography, MRI: magnetic resonance imaging, BP: blood pressure, Na: sodium, CL: chloride, CRP: C-reactive protein, aPTT: activated partial thromboplastin time
Figure 4.
Figure 4.
The results of imaging of the bilateral adrenal glands. (A) Computed tomography revealed no abnormality of the adrenal glands on Day 3. (B) The enlargement of the bilateral adrenal glands (white arrows) was evident on Day 5. (C) Axial T2-weighted magnetic resonance imaging (MRI) revealed a region of low signal intensity (white arrows).
See this image and copyright information in PMC

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