Mesenteric thrombosis as a clinical presentation of antiphospholipid syndrome: a case report and literature review
DOI:
https://doi.org/10.18203/2320-6012.ijrms20243438Keywords:
Thrombosis, Antiphospholipid antibodies, Anticardiolipin antibodies, Anti-b2-glycoprotein 1 antibodies, Lupus anticoagulant, Antiphospholipid syndrome, ThrombophiliaAbstract
Mesenteric thrombosis is a rare pathology that results from the obstruction of the arterial or venous system of the mesenteric circulation by a thrombus or embolus. The etiology of thrombus formation is rarely evident; the population statistically most affected by this pathology are older adults, with an average age of 60-70 years. The main causes related to the presentation of mesenteric thrombosis are embolic cardiac arrhythmias such as atrial fibrillation, neoplasia and prolonged prostration. In rare cases, the presence of thrombophilia, for example antiphospholipid antibody syndrome (APS), is identified as an underlying cause of thrombotic events. APS is a disease characterized by a procoagulant state; the most frequent clinical manifestations are related to thrombotic events. The pathophysiology of the disease is related to the formation of antiphospholipid antibodies. The three antibodies identified in APS are lupus anticoagulant (LA), anticardiolipin antibody (aCL) and anti-b2glycoprotein 1 antibody (anti-b2GP1). Treatment is based on the use of anticoagulant drugs with the aim of preventing the appearance of new thromboembolic events. In this article we present a clinical case of mesenteric thrombosis in a male patient in whom the presence of antiphospholipid antibodies (aPL) was documented and who met the classification criteria for APS. For the review of the literature, a search was carried out for information related to pathophysiology, clinical manifestations, classification and treatment of APS, as well as literature related to mesenteric thrombosis in open access sources and databases such as PubMed. In conclusion, APS is a rare pathology, probably because it is underdiagnosed, since in developing countries there are no resources to carry out the diagnostic approach, likewise the delay in the start of treatment implies an increase in morbidity for the patient.
Metrics
References
Ambati A, Knight J, Zuo Y. Antiphospholipid syndrome management: a 2023 update and practical algorithm-based approach. Curr Opin Rheumatol. 2023;35(3):149-60.
Knight JS, Branch DW, Ortel TL. Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management. BMJ. 2023;380:69717.
Schreiber K, Sciascia S, De Groot, Devreese K, Jacobsen S, Ruiz-Irastorza G, et al. Antiphospholipid syndrome. Nat Rev Dis Primers. 2018;11(4):17103.
El G, Taher A, Sciascia S, Uthman I. Antiphospholipid syndrome: the need for new international classification criteria. Expert Rev Clin Immunol. 2021;17(4):385-94.
Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo M, et al. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol. 2023;75(10):1687-702.
Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med. 2018;378(21):2010-21.
Valor L, Hernández D, Martínez J, López F. A reflection on how we define, determine and interpret the finding of lupus anticoagulant. Reumatol Clin (Engl Ed). 2018;14(2):120-2.
Zahidin M, Iberahim S, Hassan M, Zulkafli Z, Mohd N. Clinical and Laboratory Diagnosis of Antiphospholipid Syndrome: A Review. Cureus. 2024;16(6):61713.
Arreola R, Majluf A, Sanchez L, Hernandez J. The pathophysiology of the antiphospholipid syndrome: a perspective from the blood coagulation system. Clin Appl Thromb Hemost. 2022;28:10760.
Capozzi A, Manganelli V, Riitano G, Caissutti D, Longo A, Garofalo T, et al. Advances in the pathophysiology of thrombosis in antiphospholipid syndrome: molecular mechanisms and signaling through lipid rafts. J Clin Med. 2023;12(3):891.
Santacruz JC, Mantilla MJ, Rueda I, Pulido S, Rodríguez G, Londono J. Obstetric antiphospholipid syndrome from the perspective of a rheumatologist. Cureus. 2022;14(1):21090.
Manning JE, Arachchillage DJ. Dilemmas in the diagnosis and management of antiphospholipid syndrome. J Thromb Haemost. 2024;22(8):2156-70.
Bitsadze V, Yakubova F, Khizroeva J, Lazarchuk A, Salnikova P, Vorobev A, et al. Catastrophic Antiphospholipid Syndrome. Int J Mol Sci. 2024;25(1):668.
Siniscalchi C, Basaglia M, Riva M, Meschi M, Meschi T, Castaldo G, et al. Catastrophic Antiphospholipid Syndrome: A Review. Immuno. 2024;1:4.
Or C, Maya B, Yehuda S, Yair. Diagnosis and management of catastrophic antiphospholipid syndrome, Exp Rev Hematology, 2017;10(4):365-74.
Legault K, Schunemann H, Hillis C, Yeung C, Akl E, Carrier M, et al. McMaster RARE-Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome. J Thromb Haemost. 2018;16(8):1656-54.
Tektonidou M, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019;78(10):1296-304.
