Alghanim Khawla K, Alrayes Hezab A, Aljurbua Rayan M
Rheumatology Unit, Department of Internal Medicine, King Fahad Military Medical Complex, Dhahran, Saudi Arabia.
Eur J Case Rep Intern Med. 2022 Dec 5;9(12):003686. doi: 10.12890/2022_003686. eCollection 2022.
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.
Seronegative antiphospholipid syndrome (SN-APS) is very rare and often missed clinically.SN-APS should be treated similarly to seropositive obstetric APS to reduce recurrence.The antimalarial drug hydroxychloroquine should be considered 3 months before attempts at conception as it appears to decrease antiphospholipid levels.
我们报告了一名31岁女性的病例，其病史提示患有产科抗磷脂综合征（APS），有反复流产、早产和宫内胎儿死亡情况。在她最后一次怀孕期间，被转诊至沙特阿拉伯达兰法赫德国王军事医疗中心的风湿病诊所。结缔组织病和APS的血清学检查多次呈阴性。在之前的妊娠期间，她的产科医生曾多次尝试单独或联合预防性使用肝素的小剂量阿司匹林治疗，但均未成功。我们诊断她为血清阴性产科APS（SN - APS）。尝试了一种特定的治疗方案，即小剂量阿司匹林、低分子量肝素、羟氯喹（<5毫克/千克/天）和小剂量泼尼松龙联合治疗。尽管由于胎盘早剥，婴儿在妊娠30周时早产，但她产下了一个健康的婴儿。产科SN - APS很罕见，应予以考虑，如果病史高度提示该病，应与血清阳性产科APS进行类似治疗以降低死亡率。
血清阴性抗磷脂综合征（SN - APS）非常罕见，临床上常被漏诊。SN - APS应与血清阳性产科APS进行类似治疗以减少复发。在尝试受孕前3个月应考虑使用抗疟药羟氯喹，因为它似乎能降低抗磷脂水平。
