Hemorragia pulmonar y síndrome antifosfolipídico

Servicio de Medicina Interna. Complejo Hospitalario Xeral-Cíes. Universidad de Santiago de Compostela
Revista Clínica Española (Impact Factor: 1.06). 12/2004; 204(10):528-531. DOI: 10.1157/13066176


The presence of anti-phospholipid antibodies (anticardiolipin antibodies and lupus anticoagulant) associated to venous and/or arterial thrombotic phenomena and fetal losses define the anti-phospholipid syndrome. On rare occasions severe hypoprothrombinemia associated with this disease as a cause of hemorrhagic manifestations has been described. In addition very few cases of alveolar hemorrhage in anti-phospolipid syndrome (APS) have been described, being this complication usually related to microthrombosis and/or capillaritis of pulmonary vessels.
We describe two patients without previous clinical manifestations of anti-phospholipid syndrome that showed pulmonary hemorrhage with anticardiolipin antibodies positivity. The first of them, a 33-yearold male, began his disease with low prothrombin time and the presence of antiprothrombin antibodies. In the biopsy by thoracoscopy the presence of pulmonary hemorrhage without capillaritis nor thrombotic phenomena was demostrated, becoming evident certain clinical improvement and normalization of the prothrombin time after receiving immunosuppressive treatment but with persistence of the pulmonary hemorrhage 5 years later. The second case, a 89-year-old male, began his condition with bilateral lung infiltrates and hemoptysis, anticardiolipin antibodies positivity, and thrombopenia, with recurrence of the condition 1 year later.
After other etiological possibilities were ruled out, and despite hemorrhagic trait in both patients, we consider that they should be in the clinical context of the anti-phospholipid syndrome, although at this time they did not meet the criteria recognized in order to diagnose this disease. Within the ampliable clinical spectrum of the anti-phospholipid syndrome we should take into account the pulmonary hemorrhage.

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  • 04/2009; 10(31). DOI:10.1016/S0304-5412(09)71714-7
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    ABSTRACT: Objective To detect the pulmonary involvement in asymptomatic secondary APS patients by pulmonary function tests (PFTs) and chest multislice HRCT angiography. Comparing the pulmonary findings to those of asymptomatic SLE patients without APS was considered.Patients and methodsThirty-four SLE patients with APS and another 34 SLE patients without APS and with a negative ACL test were included as control. All patients were asymptomatic for any pulmonary manifestations. Plain chest X-ray, HRCT angiography and PFTs were performed for all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) while assessment of organ damage was made using the Systemic Lupus International Collaborating Clinics/ACR (SLICC/ACR) index.ResultsThere were abnormal pulmonary CT findings in 11 (32.35%) of the asymptomatic secondary APS patients with an obvious association to lupus anticoagulants. However, plain X-ray showed basal atelectasis and/or elevation of the copulae in four patients. Pulmonary abnormalities included a high frequency of pulmonary artery aneurysms (20.59%) thrombosis, basal atelectasis, embolism, bronchiectasis, pleural effusion and thickening. The SLEDAI and SLICC were significantly higher in APS patients. More SLE patients without APS were receiving hydroxychloroquine which suggests a protective role on the thromboembolic events occurring in APS.Conclusion Multislice HRCT pulmonary angiography, with its multiplanar capability, vascular reconstruction and high quality, is useful in demonstrating the entire thoracic spectrum in asymptomatic APS patients. Particular concern about the medications used in APS could prevent the risk of developing noticeable thromboembolic events.
    07/2012; 61(3):217–222. DOI:10.1016/j.ejcdt.2012.10.036