Bilateral Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome During Chronic Graft-versus-host Disease

Overview

Journal Intern Med

Specialty General Medicine

Date 2017 Dec 28

PMID 29279512

Citations 2

Authors

Mariko Minami

Tsuyoshi Muta

Masahiro Adachi

Masakazu Higuchi

Kenichi Aoki

Ryosuke Ogawa

Affiliations

Soon will be listed here.

Abstract

We present the case of a 56-year-old man with an upper respiratory infection followed by fatigue, hypotension, and hyponatremia. Bilateral adrenal hemorrhage was confirmed, based on T2-weighted magnetic resonance imaging. The patient had previously undergone allogeneic hematopoietic stem cell transplantation and had been diagnosed with antiphospholipid syndrome (APS) during the development of chronic graft-versus-host disease. A prompt diagnosis and steroid replacement, in addition to anticoagulant therapy, resulted in a favorable outcome. Once the diagnosis of APS has been confirmed, which might be the sign of bilateral adrenal hemorrhage, the initial manifestations of adrenal insufficiency should never be overlooked.

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References

Mengarelli A, Minotti C, Palumbo G, Arcieri P, Gentile G, Iori A . High levels of antiphospholipid antibodies are associated with cytomegalovirus infection in unrelated bone marrow and cord blood allogeneic stem cell transplantation. Br J Haematol. 2000; 108(1):126-31. DOI: 10.1046/j.1365-2141.2000.01812.x. View

Ruiz-Irastorza G, Crowther M, Branch W, Khamashta M . Antiphospholipid syndrome. Lancet. 2010; 376(9751):1498-509. DOI: 10.1016/S0140-6736(10)60709-X. View

Ritchie D, Sainani A, Dsouza A, Grigg A . Passive donor-to-recipient transfer of antiphospholipid syndrome following allogeneic stem-cell transplantation. Am J Hematol. 2005; 79(4):299-302. DOI: 10.1002/ajh.20350. View

Mortensen E, Fenton K, Rekvig O . Lupus nephritis: the central role of nucleosomes revealed. Am J Pathol. 2008; 172(2):275-83. PMC: 2312358. DOI: 10.2353/ajpath.2008.070563. View

Holbro A, Abinun M, Daikeler T . Management of autoimmune diseases after haematopoietic stem cell transplantation. Br J Haematol. 2012; 157(3):281-90. DOI: 10.1111/j.1365-2141.2012.09070.x. View

Berneis K, Buitrago-Tellez C, Muller B, Keller U, Tsakiris D . Antiphospholipid syndrome and endocrine damage: why bilateral adrenal thrombosis?. Eur J Haematol. 2003; 71(4):299-302. DOI: 10.1034/j.1600-0609.2003.00145.x. View

Sirachainan N, Pakakasama S, Hongeng S, Chuansumrit A, Tuntiyatorn L, Vilaiyuk S . Antiphospholid antibody syndrome and Hb E/Beta thalassemia disease post-allogeneic stem cell transplantation. Pediatr Blood Cancer. 2011; 57(1):153-6. DOI: 10.1002/pbc.23020. View

Yap A, Powell E, Yelland C, Mortimer R, Perry-Keene D . Lupus anticoagulant. Ann Intern Med. 1989; 111(3):262-3. DOI: 10.7326/0003-4819-111-3-262. View

Hisada R, Kato M, Sugawara E, Fujieda Y, Oku K, Bohgaki T . Thrombotic risk stratification by platelet count in patients with antiphospholipid antibodies: a longitudinal study. J Thromb Haemost. 2017; 15(9):1782-1787. DOI: 10.1111/jth.13763. View

10.

Morio S, Oh H, Hirasawa A, Aotsuka N, Nakamura H, Asai T . Hepatic veno-occlusive disease in a patient with lupus anticoagulant after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1991; 8(2):147-9. View

11.

Greeno E, Haake R, McGlave P, Weisdorf D, Verfaillie C . Lupus inhibitors following bone marrow transplant. Bone Marrow Transplant. 1995; 15(2):287-91. View

12.

Kasamon K, Drachenberg C, Rapoport A, Badros A . Catastrophic antiphospholipid syndrome: atypical presentation in the setting of chronic graft versus host disease: case report and review of the literature. Haematologica. 2005; 90(3):ECR17. View

13.

Krenger W, Blazar B, Hollander G . Thymic T-cell development in allogeneic stem cell transplantation. Blood. 2011; 117(25):6768-76. PMC: 3128475. DOI: 10.1182/blood-2011-02-334623. View

14.

Hashimoto H, Yamanaka K, Tokano Y, Iida N, Takasaki Y, Kabasawa K . HLA-DRB1 alleles and beta 2 glycoprotein I-dependent anticardiolipin antibodies in Japanese patients with systemic lupus erythematosus. Clin Exp Rheumatol. 1998; 16(4):423-7. View

15.

Sohngen D, Heyll A, Meckenstock G, Aul C, Wolf H, Schneider W . Antiphospholipid syndrome complicating chronic graft-versus-host disease after allogeneic bone marrow transplantation. Am J Hematol. 1994; 47(2):143-4. DOI: 10.1002/ajh.2830470218. View

16.

Qasim W, Gerritsen B, Veys P . Anticardiolipin antibodies and thromboembolism after BMT. Bone Marrow Transplant. 1998; 21(8):845-7. DOI: 10.1038/sj.bmt.1701184. View

17.

Espinosa G, Santos E, Cervera R, Piette J, de la Red G, Gil V . Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine (Baltimore). 2003; 82(2):106-18. DOI: 10.1097/00005792-200303000-00005. View

18.

Quaranta S, Shulman H, Ahmed A, Shoenfeld Y, Peter J, McDonald G . Autoantibodies in human chronic graft-versus-host disease after hematopoietic cell transplantation. Clin Immunol. 1999; 91(1):106-16. DOI: 10.1006/clim.1998.4666. View