Shirai T, Sato A, Chida K, Hayakawa H, Yasumi T
Department of Internal Medicine, Hamamatsu Red Cross Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Jul;32(7):700-3.
A 76-year-old man was admitted to our hospital in December of 1990, for investigation of progressive dyspnea on exertion over the previous 3 months. Physical examination revealed cyanosis, but no edema. Cardiomegaly was seen on chest X-ray, and findings compatible with right-sided congestive heart failure were revealed by ECG and echocardiography. Lung perfusion scintigrams showed multiple defects in both lungs, but no abnormal findings were detected on a ventilation study. Venograms of the lower extremities disclosed thrombosis of the right femoral vein. Therefore, a diagnosis of recurrent pulmonary thromboembolism was made. Furthermore, lupus anticoagulant and IgG-class anticardiolipin antibody were noted in the serum. The patient was treated with intravenous heparin, long-term warfarin, and transvenous placement of a Greenfield filter in the inferior vena cava. The clinical symptoms and signs improved, and no recurrence has been seen during the 13 months since the onset. On discharge, both antiphospholipid antibodies were negative. This case of primary antiphospholipid syndrome without autoimmune disease, with transiently positive antibodies only in the exacerbation phase, is discussed herein.
一名76岁男性于1990年12月入住我院，以调查其在过去3个月中进行性劳力性呼吸困难的原因。体格检查发现有发绀，但无水肿。胸部X线检查显示心脏扩大，心电图和超声心动图检查发现符合右侧充血性心力衰竭的表现。肺灌注闪烁扫描显示双肺有多个缺损，但通气研究未发现异常。下肢静脉造影显示右股静脉血栓形成。因此，诊断为复发性肺血栓栓塞。此外，血清中检测到狼疮抗凝物和IgG类抗心磷脂抗体。患者接受了静脉肝素、长期华法林治疗，并经静脉在下腔静脉置入了格林菲尔德滤器。临床症状和体征有所改善，自发病以来的13个月中未见复发。出院时，两种抗磷脂抗体均为阴性。本文讨论了这例无自身免疫性疾病的原发性抗磷脂综合征病例，其抗体仅在病情加重期短暂呈阳性。
