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病例报告:以脑静脉窦血栓形成作为首发表现的小儿原发性灾难性抗磷脂综合征。

Case Report: Primary catastrophic antiphospholipid syndrome in a pediatric patient with cerebral venous sinus thrombosis as the first manifestation.

作者信息

Xu Lingyang, Wu Jing, Wang Haidong, Yang Baowang

机构信息

Pediatric Intensive Care Unit, The Second Hospital of Lanzhou University, Lanzhou, China.

出版信息

Front Pediatr. 2024 Dec 11;12:1491095. doi: 10.3389/fped.2024.1491095. eCollection 2024.

Abstract

BACKGROUND

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by recurrent vascular thrombotic events. Catastrophic APS (CAPS), which can result in multiple organ failure and even death, is the most severe manifestation of APS. Herein, we report the case of a pediatric patient with CAPS, including the clinical course, diagnosis, and treatment, with the goal of expanding the literature on this condition, as reports of CAPS in pediatric patients are rare.

CASE PRESENTATION

A 7-year-old girl presented with cranial hypertension. She was initially admitted to the hospital with a diagnosis of cerebral venous sinus thrombosis (CVST) and was discharged following symptom improvement. However, only 3 days later, the patient was re-presented with cranial hypertension and multiple thromboses and was ultimately diagnosed with CAPS based on multidisciplinary consensus. Despite treatment with a series of anticoagulation and thrombolytic therapies, the child's condition progressed rapidly, and she eventually died of pulmonary embolism.

CONCLUSION

CAPS in children is rare and associated with a high mortality rate, making early recognition and diagnosis critical but difficult. Based on the presented case, we recommend routine screening for antiphospholipid antibodies in children with CVST without obvious triggers, or a multidisciplinary collaboration, to facilitate the early diagnosis of CAPS.

摘要

背景

抗磷脂综合征(APS)是一种以反复血管血栓形成事件为特征的自身免疫性疾病。灾难性抗磷脂综合征(CAPS)可导致多器官功能衰竭甚至死亡,是APS最严重的表现形式。在此,我们报告一例小儿CAPS病例,包括临床病程、诊断和治疗,目的是扩充关于这种疾病的文献,因为小儿CAPS的报道很少。

病例介绍

一名7岁女孩出现颅内高压。她最初因诊断为脑静脉窦血栓形成(CVST)入院,症状改善后出院。然而,仅3天后,患者再次出现颅内高压和多处血栓形成,最终根据多学科共识诊断为CAPS。尽管接受了一系列抗凝和溶栓治疗,但患儿病情进展迅速,最终死于肺栓塞。

结论

儿童CAPS罕见且死亡率高,早期识别和诊断至关重要但具有挑战性。基于所呈现的病例,我们建议对无明显诱因的CVST患儿常规筛查抗磷脂抗体,或进行多学科协作,以促进CAPS的早期诊断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8586/11668558/49d442acf7f6/fped-12-1491095-g001.jpg

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