Occlusion of left common carotid artery in a patient with systemic lupus erythematosus and antiphospholipid syndrome: A case report

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  • 左総頸動脈閉塞をきたしたＳＬＥに続発した抗リン脂質抗体症候群の１例

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Abstract

A 34-year-old woman, who had gradually developed right lower-limb-dominant hemiparesis over two days, was admitted to the Department of Neurology at our hospital. Buccal erythema, hyperesthesia, and low-grade fever had occurred occasionally during the 3 years before presentation. On admission, the platelet count was 89000/mm3. Diffusion-weighted (DW) MRI showed multiple cerebral infarcts in the left frontal and parietal lobes. MRA showed occlusion of the left common carotid artery. Transesophageal echocardiography showed spontaneous echo contrast within the left atrium. Transvenous echo of the lower limbs showed deep vein thrombi (DVT). She was given aspirin, heparin, and edaravone. The next day, delirium developed. DW MRI showed a large infarction from the left lobe to the parietal lobe. Intravenous methylprednisolone (1000 mg/day) was given for 3 days. After 6 days, she became alert; however, right hemiparesis and transcortical motor aphasia remained. After 7 days, ANA, ds-DNA and lupus anticoagulant (LA) were positive. She was given a diagnosis of SLE on the basis of the buccal erythema, hyperesthesia, low platelet count, and positive tests for ANA and ds-DNA. Antiphopholipid syndrome (APS) accompanied by SLE was diagnosed on the basis of the brain infarction, DVT, and positive repeated tests for LA, and she received prednisolone, aspirin, and warfarin. After 2 months, the neurological symptoms improved, and she was discharged.<br>APS was suspected on the basis of the patient s age, sex, medical history, and results of neurologic examinations. Although antibodies for APS cannot be measured on emergency admission, early treatment of APS is essential.

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