An extraordinary case of recurrent stroke, disseminated thrombosis and endocarditis.
A 43-year-old woman with no known cardiovascular risk factors was admitted with a second episode of ischaemic stroke. She was not a known case of connective tissue disease like systemic lupus erythematosus or antiphospholipid syndrome (APS). During the current episode, she was found to have markedly deranged coagulation parameters and laboratory evidence of microangiopathic haemolysis, but no evidence of sepsis or active bleeding. Further investigation revealed multiple organ infarcts. A diagnosis of probable catastrophic APS was made and she improved dramatically with a combination of plasmapheresis, corticosteroids and therapeutic anticoagulation. Serological markers of APS were negative. Her hospital course was complicated by Libman Sacks endocarditis with significant aortic regurgitation that improved markedly with anticoagulation obviating the need for high-risk cardiac surgery. At discharge, she was stable and well and was advised long-term anticoagulation and rheumatology follow-up.
['Thomas|Liza Mariam|LM|http://orcid.org/0000-0002-8253-2451', 'Shaikh|Niaz Ahmed|NA|', 'Pradeep|Ranjana|R|']
D000305:Adrenal Cortex Hormones D000328:Adult D000925:Anticoagulants D016736:Antiphospholipid Syndrome D001022:Aortic Valve Insufficiency D001921:Brain D002388:Catastrophic Illness D061345:Early Medical Intervention D004617:Embolism D004696:Endocarditis D005260:Female D006801:Humans D007238:Infarction D007674:Kidney Diseases D010956:Plasmapheresis D011655:Pulmonary Embolism D012008:Recurrence D013159:Splenic Infarction D020521:Stroke D014057:Tomography, X-Ray Computed
stroke connective tissue disease malignant and benign haematology valvar diseases vasculitis