CHSU Discovery

Amongst 40% of population with SLE who test positive for Antiphospholipid antibodies (aPL) only 7-15% of the patients develop Antiphospholipid antibody syndrome. Repeat aPL after a duration of 12 or more weeks and lack of continuity of care can sometime pose a challenge to establish a definitive diagnosis in medically underserved areas of the Central Valley. This patient case report highlights a young female patient with SLE, Diabetes Type II, hypothyroidism and recurrent abortions due to unknown etiology came in with fatigue, diaphoresis and progressive worsening of left arm pain for 2 days. Pertinent physical exam findings showed generalized tenderness and swelling in the left arm with Raynaud’s phenomenon in bilateral upper extremity digits and no focal weakness. Initial evaluation ruled out ACS and hypoglycemia. US doppler LUE vein showed venous thrombosis of the mid and distal left brachial, the left basilic, left ulnar and left radial as well as the cephalic vein. Rheumatology and Hematologist were consulted. Further workup during the course of 12 day stay at Adventist Health Hanford showed triple +ve aPL profile. Patient was treated and discharged on warfarin for DVT and continued home dose of Hydroxychloroquine. Repeat outpatient follow up at Consultant Rheumatologist clinic after a period of nearly 5 months showed elevated aPL, thus confirming the diagnosis of APS. Mortality of APS associated with SLE. SLE-APS patients exhibit more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients. Antithrombotic therapy with warfarin or aspirin may reduce the risk of recurrent thromboembolic complications but does not eliminate the risk.