Emad Y, Ragab Y, El-Marakbi A, Saad A, Ibrahim O, Abd-Elhalim A, El-Santawi H, Rasker J J
Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Z Rheumatol. 2019 May;78(4):365-371. doi: 10.1007/s00393-019-0618-7.
Hughes-Stovin syndrome (HSS), characterized by the combination of multiple pulmonary artery aneurysms and deep vein thrombosis, is a rare and an under-recognized clinical entity with less than 40 published cases in English medical literature. Vascular venous thrombotic events, as occurring in the course of Behçet's disease (BD), are also described in HSS, e. g., vena cava, intra-cardiac, jugular vein, iliac vein, femoral vein, and dural sinus thrombosis. We describe a 35-year-old man with HSS showing classical features of the syndrome in the form of recurrent thrombophlebitis of the lower limb veins, pulmonary arterial aneurysms, and left lower limb ischemia with extensive arterial tree involvement. The patient presented with critical arterial ischemia in the left lower limb together with aortic and left common iliac artery thrombosis, occlusion of the left superficial femoral artery, and occlusion of both lower limb arteries. Urgent vascular surgeries were carried out for limb salvage. Shortly after, the patient started on pulse corticosteroid/cyclophosphamide therapy, followed by monthly cyclophosphamide for 1 year, with much improvement. We discuss arterial involvement in HSS and similarities of HSS and BD regarding thrombotic events. We summarize the current management options of HSS.
休斯-斯托文综合征(HSS)以多发性肺动脉瘤和深静脉血栓形成并存为特征,是一种罕见且未得到充分认识的临床病症,英文医学文献中报道的病例不足40例。白塞病(BD)病程中出现的血管静脉血栓形成事件在HSS中也有描述,例如腔静脉、心内、颈静脉、髂静脉、股静脉和硬脑膜窦血栓形成。我们描述了一名35岁的HSS男性患者,其表现出该综合征的典型特征,如下肢静脉反复血栓性静脉炎、肺动脉瘤以及累及广泛动脉树的左下肢缺血。该患者表现为左下肢严重动脉缺血,同时伴有主动脉和左髂总动脉血栓形成、左股浅动脉闭塞以及双下肢动脉闭塞。为挽救肢体进行了紧急血管手术。此后不久,患者开始接受脉冲式皮质类固醇/环磷酰胺治疗,随后每月使用环磷酰胺治疗1年,病情有了很大改善。我们讨论了HSS中的动脉受累情况以及HSS和BD在血栓形成事件方面的相似性。我们总结了HSS目前的治疗选择。