Severe limb necrosis: primary thrombotic microangiopathy or "seronegative" catastrophic antiphospholipid syndrome? A diagnostic dilemma
An episode of gastroenteritis triggered severe necrosis of all extremities in a previously asymptomatic male. Hepatic and renal involvement were also manifest, while the hematological picture was one of thrombotic microangiopathic hemolytic anemia. Antiphospholipid antibodies were negative. He respo...
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| Veröffentlicht in: | Clinical rheumatology 2007-10, Vol.26 (10), p.1737-1740 |
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| container_title | Clinical rheumatology |
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| creator | Lazurova, I Macejova, Z Tomkova, Z Remenar, F Boor, A Lazur, J Roland, R Rovensky, J Asherson, R A |
| description | An episode of gastroenteritis triggered severe necrosis of all extremities in a previously asymptomatic male. Hepatic and renal involvement were also manifest, while the hematological picture was one of thrombotic microangiopathic hemolytic anemia. Antiphospholipid antibodies were negative. He responded well to a combination of plasma exchange, anticoagulation (heparin), parenteral steroids, and antibiotics, as well as vasodilators (prostacycline) and hyperbaric oxygen, but died because of a cerebral hemorrhage. The differential diagnosis included thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome, or seronegative catastrophic antiphospholipid (Asherson's) syndrome. The dangers of administering such a combination of therapies with anticoagulation, as well as vasodilatation (prostacycline) and hyperbaric oxygen, are highlighted by the case report and emphasized. |
| doi_str_mv | 10.1007/s10067-006-0487-8 |
| format | Article |
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A diagnostic dilemma</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lazurova, I ; Macejova, Z ; Tomkova, Z ; Remenar, F ; Boor, A ; Lazur, J ; Roland, R ; Rovensky, J ; Asherson, R A</creator><creatorcontrib>Lazurova, I ; Macejova, Z ; Tomkova, Z ; Remenar, F ; Boor, A ; Lazur, J ; Roland, R ; Rovensky, J ; Asherson, R A</creatorcontrib><description>An episode of gastroenteritis triggered severe necrosis of all extremities in a previously asymptomatic male. Hepatic and renal involvement were also manifest, while the hematological picture was one of thrombotic microangiopathic hemolytic anemia. Antiphospholipid antibodies were negative. He responded well to a combination of plasma exchange, anticoagulation (heparin), parenteral steroids, and antibiotics, as well as vasodilators (prostacycline) and hyperbaric oxygen, but died because of a cerebral hemorrhage. The differential diagnosis included thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome, or seronegative catastrophic antiphospholipid (Asherson's) syndrome. 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A diagnostic dilemma</title><title>Clinical rheumatology</title><addtitle>Clin Rheumatol</addtitle><description>An episode of gastroenteritis triggered severe necrosis of all extremities in a previously asymptomatic male. Hepatic and renal involvement were also manifest, while the hematological picture was one of thrombotic microangiopathic hemolytic anemia. Antiphospholipid antibodies were negative. He responded well to a combination of plasma exchange, anticoagulation (heparin), parenteral steroids, and antibiotics, as well as vasodilators (prostacycline) and hyperbaric oxygen, but died because of a cerebral hemorrhage. The differential diagnosis included thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome, or seronegative catastrophic antiphospholipid (Asherson's) syndrome. The dangers of administering such a combination of therapies with anticoagulation, as well as vasodilatation (prostacycline) and hyperbaric oxygen, are highlighted by the case report and emphasized.</description><subject>Anemia</subject><subject>Antiphospholipid Syndrome - diagnosis</subject><subject>Antiphospholipid Syndrome - mortality</subject><subject>Antiphospholipid Syndrome - pathology</subject><subject>Cerebral Hemorrhage</subject><subject>Diagnosis, Differential</subject><subject>Epoprostenol - pharmacology</subject><subject>Extremities - pathology</subject><subject>Fatal Outcome</subject><subject>Gastroenteritis - complications</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Necrosis - pathology</subject><subject>Oxygen</subject><subject>Oxygen - metabolism</subject><subject>Thrombosis - diagnosis</subject><subject>Thrombosis - mortality</subject><subject>Thrombosis - pathology</subject><subject>Vascular Diseases - diagnosis</subject><subject>Vascular Diseases - mortality</subject><subject>Vascular Diseases - pathology</subject><issn>0770-3198</issn><issn>1434-9949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkcFq3DAQhkVoSTZpHyCXIPbQmxuNJUtyLiWENg0EekhyFrIk7yrYliNpA_sEfe3I7EKhh_nnMN_8DPMjdAnkOxAirlNRLqoiFWFSVPIErYBRVrUtaz-hFRGCVBRaeYbOU3olhNSyhVN0BqJuOBC6Qn-f3LuLDg9-7PDkTAzJpxs8Rz_quMd5G8PYhewNHn0Z6mnjw6zzdo9DxOvkYpjcRmf_7tbY6KxTjmHeFlxP2c_bkEoNfvYWp_1ki5n7gW-x9XozhbTYWj-4cdRf0OdeD8l9PfYL9PLr5_Pd7-rxz_3D3e1jZWjNcwWG6EZCX1srGtZATzsKxhDWCdN3shcdtD3nhlJNTS-EhUazWjMiuaWOaXqBvh185xjedi5lNfpk3DDoyYVdUlzWogEhCrj-D3wNuziV25SUQCVnXBYIDtDytxRdr46PU0DUEpE6RKSKqCUitexcHY133ejsv41jJvQDpR6Ppw</recordid><startdate>20071001</startdate><enddate>20071001</enddate><creator>Lazurova, I</creator><creator>Macejova, Z</creator><creator>Tomkova, Z</creator><creator>Remenar, F</creator><creator>Boor, A</creator><creator>Lazur, J</creator><creator>Roland, R</creator><creator>Rovensky, J</creator><creator>Asherson, R A</creator><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20071001</creationdate><title>Severe limb necrosis: primary thrombotic microangiopathy or "seronegative" catastrophic antiphospholipid syndrome? 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| ispartof | Clinical rheumatology, 2007-10, Vol.26 (10), p.1737-1740 |
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| subjects | Anemia Antiphospholipid Syndrome - diagnosis Antiphospholipid Syndrome - mortality Antiphospholipid Syndrome - pathology Cerebral Hemorrhage Diagnosis, Differential Epoprostenol - pharmacology Extremities - pathology Fatal Outcome Gastroenteritis - complications Humans Male Middle Aged Necrosis - pathology Oxygen Oxygen - metabolism Thrombosis - diagnosis Thrombosis - mortality Thrombosis - pathology Vascular Diseases - diagnosis Vascular Diseases - mortality Vascular Diseases - pathology |
| title | Severe limb necrosis: primary thrombotic microangiopathy or "seronegative" catastrophic antiphospholipid syndrome? A diagnostic dilemma |
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