Atrial thrombus as a complication of SLE and APS in an 8-year-old child
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CASE REPORT
Open Access
Atrial thrombus as a complication of SLE and APS in an 8-year-old child Hai-bo Yan and Yu-mei Li*
Abstract Background: Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems with various clinical manifestations. Renal involvement is common, but intracardiac thrombus is rarely reported as a complication of antiphospholipid syndrome (APS, also known as anticardiolipin syndrome). Anticoagulant therapy is the first-line treatment, and surgery is performed in severe cases. We report a case to improve clinicians’ understanding of disease diagnosis. Case presentation: An 8-year-old girl was admitted to our hospital because of left costal pain, hematuria and fever. She had obvious edema occult blood 3+, urinary protein 3.2 g/24 h, albumin 17.6 g/L, and total cholesterol 7.21 mmol/L, consistent with a diagnosis of nephrotic syndrome. We continued to track the etiology of nephrotic syndrome and performed a renal biopsy, showing dsDNA 1:10 positivity, low C3, low platelets and hemoglobin, anticardiolipin IgM 12 U/ml, anti-β2-glycoprotein I (β2GPI) 223 U/ml; renal pathology suggested lupus nephritis (LN), and the patient was ultimately diagnosed with SLE, secondary APS and LN. The patient was treated with hormones and immunosuppressants. Sixteen weeks later, her urinary protein was 1+, and the quantity of urine protein was less than 0.5 g/d. Echocardiography showed that the mass in the right atrium was thrombotic. Heparin anticoagulant therapy was effective. Conclusion: SLE can involve multiple systems and various complications. Thrombus in the right atrium is a rare complication of APS. Early diagnosis and treatment are key to improving the prognosis of children. Keywords: Systemic lupus erythematosus, Nephrotic syndrome, Anticardiolipin antibody syndrome, Atrial thrombus
Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with various clinical manifestations. Lupus nephritis (LN) is a common manifestation of SLE. Anticardiolipin antibody syndrome is easily complicated by thrombi, but intracardiac thrombosis is rare. Here, we report a child with nephrotic syndrome who was then diagnosed with SLE and secondary anticardiolipin antibody syndrome complicated by right atrial thrombus.
* Correspondence: [email protected] Department of Pediatric Critical Medicine, The First Hospital of Jilin University, 71 Xin Min Street, Changchun 130000, China
Case presentation An 8-year-old female who presented with left rib pain, hematuria and fever was admitted to our hospital. The maximum temperature reached 39.9 °C, with no chills or rash. She was administered cefepime and azithromycin for 1 day, cefotaxime for 5 days, and methylprednisolone for 1 day. On physical examination, her general condition was poor, with eyelid and lower limb edema; coarse respiratory sounds and auscultation of blisters of both lungs were noted, and no other abnormal findings were present at that time. Laboratory findings were as follows: white blood cell count 6.32*109/L,
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