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Bilateral adrenal hemorrhage in APLS (anti-phospholipid syndrome) patient on Novel Anticoagulant: a case report

Ebtisam A Bakhsh, Reem A Alkhathami, Shazia Mukaddam, Ohoud Alarfaj.

Abstract
Background: Antiphospholipid syndrome is a prothrombotic state characterized by the existence of persistent antiphospholipid antibodies. The key sequence of events is focal microthrombosis and post-infarction hemorrhage in the adrenal glands. Use of anticoagulant therapy is often used as a prevention and treatment among patients.

Case presentation: We describe a case of 40 year old female who visited Emergency Room with complain of severe right upper quadrant pain for two days associated with nausea and vomiting. Initial laboratory investigations of blood, liver, and renal functions were normal. CT scan of abdomen revealed diffused enlargement of the right adrenal gland and showed relatively less enhancement indicating hemorrhage at the right side which later developed bilateral during admission. A day after admission, platelet count was 60,000 accompanied with worsened abdominal pain lead to diagnosis of catastrophic Anti-phospholipid syndrome (APLS).

Conclusion: APS may lead to a variety of clinical manifestations due to venous and/or arterial thrombosis, so prescribing novel anticoagulants for patients with the APS is selective, and multiple factors are needed to be considered for a successful treatment.

Key words: Antiphospholipid syndrome, adrenal hemorrhage, case report, anticoagulant therapy, bilateral hemorrhage, adrenal insufficiency


 



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