Dorsolateral medullary infarction during skin infection by Stenotrophomonas maltophilia in a patient with triple antipho
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CASE BASED REVIEW
Dorsolateral medullary infarction during skin infection by Stenotrophomonas maltophilia in a patient with triple antiphospholipid antibody positivity: a case-based review Yu-Lan Chen 1 & Hai-Tao Yang 1 & Li-Xiong Liu 1 & Cui-Hong Chen 1 & Qin Huang 1 & Xiao-Ping Hong 1 & Jiu-Liang Zhao 2 & Dong-Zhou Liu 1 Received: 20 September 2020 / Revised: 20 October 2020 / Accepted: 28 October 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Thrombotic events are the most frequent causes of death in patients with antiphospholipid syndrome (APS). Previous studies have reported infection to be the most important trigger of thrombosis in APS, with molecular mimicry considered to be a major mechanism. Although timely management of infections has been recommended in patients with high suspicion of infection, antiinfective therapy would not take effect in a short time due to the dilemma in determining the origins of infection, especially in patients undergoing immunosuppressive therapy. Here, we describe a 26-year-old patient with systemic lupus erythematosus with triple antiphospholipid antibody positivity who had a stroke involving her dorsolateral medulla, despite timely anti-infective treatment within the context of skin infection caused by Stenotrophomonas maltophilia. To the best of our knowledge, it is the first report about the association between Stenotrophomonas maltophilia infection and thrombotic complications in APS. Thus, solely focusing on anti-infective therapy by the current recommendation for the management of APS may be insufficient within the context of infection; early initiation of effective anticoagulation should also be suggested until the anti-infective therapy becomes effective, especially in patients with high-risk antiphospholipid antibody profiles, in whom the potential benefit would outweigh the risk of bleeding. Keywords Anticoagulation . Antiphospholipid syndrome . Dorsolateral medulla infarction . High risk . Infection
Introduction Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by the occurrence of venous and arterial
Yu-Lan Chen and Hai-Tao Yang contributed equally to this paper. * Jiu-Liang Zhao [email protected] * Dong-Zhou Liu [email protected] 1
Department of Rheumatology and Immunology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen 518020, People’s Republic of China
2
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing 100730, People’s Republic of China
thrombosis as well as obstetric manifestations due to the presence of pathogenic autoantibodies known as antiphospholipid antibodies (aPLs), including lupus anticoagulant (LA), anticardiolipin antibodies (anti-CL), and anti-β2 gly
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