Nardella Francis A
Rheumatology, St. Luke's Meridian Medical Center, Meridian, USA.
Cureus. 2024 Dec 18;16(12):e75977. doi: 10.7759/cureus.75977. eCollection 2024 Dec.
This report describes the development of recurrent cutaneous microthrombosis in a patient with the superposition of Factor V Leiden heterozygosity on a noncriteria IgM antibody to phosphatidylserine/prothrombin complex. The patient was treated with prednisone, apixaban, and rituximab and was stable off of prednisone at her last outpatient visit 22 months after the initial event. This report illustrates the challenges of dealing with multifactor thrombophilia especially when one of those factors is a noncriteria antiphospholipid antibody and reaffirms the value of testing for noncriteria antibodies when clinical findings suggest the presence of antiphospholipid antibodies but the criteria antibodies are negative. This report further shows, in this patient, the benefit of the addition of rituximab-pvv to apixaban in normalizing the level of antiphosphatidylserine/prothrombin complex antibodies with the cessation of cutaneous microthrombotic events, normalization of inflammatory markers, and allowing the discontinuation of prednisone. Because of the relatively high frequency of Factor V Leiden heterozygosity in Caucasian populations, this report suggests that dual-factor thromobophilia due to its combination with criteria or noncriteria antiphospholipid antibodies may be more common than is recognized.
本报告描述了一名患者复发性皮肤微血栓形成的情况，该患者存在因子V莱顿杂合性，同时伴有针对磷脂酰丝氨酸/凝血酶原复合物的非标准IgM抗体。患者接受了泼尼松、阿哌沙班和利妥昔单抗治疗，在初始事件发生22个月后的最后一次门诊就诊时，停用泼尼松后病情稳定。本报告说明了处理多因素血栓形成倾向的挑战，尤其是当其中一个因素是非标准抗磷脂抗体时，并再次强调当临床发现提示存在抗磷脂抗体但标准抗体为阴性时检测非标准抗体的价值。本报告进一步表明，在该患者中，在阿哌沙班基础上加用利妥昔单抗-pvv可使抗磷脂酰丝氨酸/凝血酶原复合物抗体水平恢复正常，皮肤微血栓形成事件停止，炎症标志物恢复正常，并可停用泼尼松。由于白种人群中因子V莱顿杂合性的频率相对较高，本报告提示，由其与标准或非标准抗磷脂抗体组合导致的双因素血栓形成倾向可能比目前认识到的更为常见。
