Seronegative Obstetric Antiphospholipid Syndrome Finally Treated Successfully
  • Khawla K Alghanim
    Rheumatology Unit, Department of Internal Medicine, King Fahad Military Medical Complex, Dhahran, Saudi Arabia http://orcid.org/0000-0002-5226-3254
  • Hezab A Alrayes
    Rheumatology Unit, Department of Internal Medicine, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
  • Rayan M Aljurbua
    Rheumatology Unit, Department of Internal Medicine, King Fahad Military Medical Complex, Dhahran, Saudi Arabia

Keywords

APS, antiphospholipid syndrome, SN-APS, seronegative APS, IUFD, intrauterine fetal death

Abstract

We report the case of a 31-year-old woman with a history suggestive of obstetric antiphospholipid syndrome (APS) with recurrent miscarriages, preterm labour and intrauterine fetal death. During her last pregnancy, she was referred to the Rheumatology Clinic at King Fahad Military Medical Complex, Dhahran, Saudi Arabia. Serology for connective tissue diseases and APS was negative on multiple occasions. During previous pregnancies, her obstetrician had initiated several trials of baby aspirin with and without prophylactic heparin, without success. We diagnosed her with seronegative obstetric APS (SN-APS). A specific regimen, consisting of combination therapy with baby aspirin, low-molecular-weight heparin, hydroxychloroquine (<5 mg/kg/day) and low-dose prednisolone, was attempted. She delivered a healthy baby even though it was born preterm at 30 weeks of gestation because of abruptio placentae. Obstetric SN-APS is rare and should be considered and, if the history is highly suggestive, treated similarly to seropositive obstetric APS to reduce mortality.

VIEW THE ENTIRE ARTICLE

References

  • Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 2018;378:2010–2021. doi: https://doi.org/10.1056/nejmra1705454Hughes GR, Khamashta MA. Seronegative antiphospholipid syndrome. Ann Rheum Dis 2003;62:1127. doi: https://doi.org/10.1136/ard.2003.006163
  • Drouvalakis KA, Buchanan RR. Phospholipid specificity of autoimmune and drug induced lupus anticoagulants; association of phosphatidylethanolamine reactivity with thrombosis in autoimmune disease. J Rheumatol 1998;25:290–295.
  • Shoenfeld Y, Twig G, Katz U, Sherer Y. Autoantibody explosion in antiphospholipid syndrome. J Autoimmun 2008;30:74–83. doi: https://doi.org/10.1016/j.jaut.2007.11.011
  • Pignatelli P, Ettorre E, Menichelli D, Pani A, Violi F, Pastori D. Seronegative antiphospholipid syndrome: refining the value of “non-criteria” antibodies for diagnosis and clinical management. Haematologica 2020;105:562–572. doi: https://doi.org/10.3324/haematol.2019.221945
  • Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR Recommendation for the management of antiphospholipid syndrome in adults.>Ann Rheum Dis 2019;78:1296–1304. doi: https://doi.org/10.1136/annrheumdis-2019-215213
  • Bramham K, Thomas M, Nelson-Piercy C, Khamashta M, Hunt BJ. First-trimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss. Blood 2011;117:6948–6951. doi: https://doi.org/10.1182/blood-2011-02-339234
  • Mekinian A, Lazzaroni MG, Kuzenko A, Alijotas-Reig J, Ruffatti A, Levy P, et al. The efficacy of hydroxychloroquine for obstetrical outcome in anti-phospholipid syndrome: Data from a European multicenter retrospective study. Autoimmun Rev 2015;14:498–502. doi: https://doi.org/10.1016/j.autrev.2015.01.012
  • Toubi E, Kessel A, Rosner I, Rozenbaum M, Lorber M, Paran D, et al. Quinacrine added to ongoing therapeutic regimens attenuates anticardiolipin antibody production in SLE. Lupus 2003;12:297. doi: https://doi.org/10.1191/0961203303lu319oa

    • Views: 511
    HTML downloads: 94
    PDF downloads: 408

    Published: 2022-12-05
    Issue: 2022: Vol 9 No 12 (view)

    How to cite:
    1.
    Alghanim KK, Alrayes HA, Aljurbua RM. Seronegative Obstetric Antiphospholipid Syndrome Finally Treated Successfully. EJCRIM 2022;9 doi:10.12890/2022_003686.