Wang Yuwei, Jin Di, Pang Jiangang, Ju Wenlong, Nie Weiduo, Gao Rui, Li Sheng-Guang, Li Ming
Department of Emergency Internal Medicine, Weifang People's Hospital, Shandong, Weifang, China.
Department of Rheumatology, Weifang People's Hospital, Shandong, Weifang, China.
Front Immunol. 2025 Aug 12;16:1632069. doi: 10.3389/fimmu.2025.1632069. eCollection 2025.
This case report describes a rare and life-threatening complication of bilateral adrenal hemorrhage (AH) in a 15-year-old female with overlapping systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The patient presented with prolonged abdominal pain, low-grade fever, and lower limb pain. Imaging revealed bilateral adrenal hemorrhages, while laboratory investigations confirmed triple-positive antiphospholipid antibodies (ACA-IgG, ACA-IgM, anti-β2 glycoprotein I) and SLE-related serological markers. Management involved dual-pathway therapy: immunosuppression (prednisone, hydroxychloroquine) for SLE and anticoagulation (low-molecular-weight heparin, warfarin) for APS. Despite initial improvement, adrenal insufficiency developed, requiring glucocorticoid replacement. Follow-up demonstrated stabilized clinical status and reduced adrenal lesions. This case underscores the diagnostic challenges of AH in SLE-APS overlap and emphasizes the necessity of combining immunosuppressive and anticoagulant therapies to address both autoimmune inflammation and thrombotic risks. Early recognition and multidisciplinary management are critical to prevent adrenal crisis and improve outcomes in such complex autoimmune-thrombotic pathologies.
本病例报告描述了一名15岁女性，患有重叠性系统性红斑狼疮（SLE）和抗磷脂综合征（APS），出现双侧肾上腺出血（AH）这一罕见且危及生命的并发症。患者表现为持续性腹痛、低热和下肢疼痛。影像学检查显示双侧肾上腺出血，而实验室检查证实抗磷脂抗体三联阳性（抗心磷脂IgG、抗心磷脂IgM、抗β2糖蛋白I）以及SLE相关血清学标志物阳性。治疗采用双途径疗法：针对SLE进行免疫抑制治疗（泼尼松、羟氯喹），针对APS进行抗凝治疗（低分子肝素、华法林）。尽管初期病情有所改善，但仍出现了肾上腺功能不全，需要进行糖皮质激素替代治疗。随访显示临床状况稳定，肾上腺病变减轻。本病例强调了SLE-APS重叠综合征中AH的诊断挑战，并强调了联合免疫抑制和抗凝治疗以应对自身免疫性炎症和血栓形成风险的必要性。早期识别和多学科管理对于预防肾上腺危象以及改善此类复杂的自身免疫-血栓形成性疾病的预后至关重要。
