Antiphospholipid Syndrome in a Patient with Systemic Lupus Erythematosus: A Case Report

Antiphospholipid Syndrome (APS), also known as Hughes syndrome, is an autoimmune disorder characterized by hypercoagulability and the presence of antiphospholipid antibodies (aPL). It may occur as a primary condition or secondary to other autoimmune diseases, most commonly Systemic Lupus Erythematosus (SLE). We report a case of secondary APS associated with SLE, highlighting the diagnostic and management challenges. A ۴۸-year-old female with a history of rheumatoid arthritis, hypothyroidism, and hypertension presented with severe hypoxemia, with oxygen saturation of ۵۱%. Laboratory investigations revealed mild anemia (۸.۲ g/dL), prolonged prothrombin time (۱۵.۲ seconds), and a subtherapeutic INR (۱.۱) despite ongoing anticoagulation therapy. Autoimmune panel testing confirmed SLE, and specific antiphospholipid antibody testing was positive for lupus anticoagulant, with elevated anticardiolipin IgG/IgM and anti-β۲ glycoprotein I antibodies, consistent with secondary APS. Although she was receiving Acitrom, inadequate anticoagulation raised concern for thrombotic complications, including pulmonary embolism. Azathioprine was discontinued due to the heightened risk of infection in the setting of immunosuppression and respiratory compromise. This case underscores the importance of considering APS in patients with autoimmune conditions presenting with thrombotic manifestations, particularly in the presence of SLE. It highlights the need for meticulous monitoring of anticoagulation, prompt recognition of thrombotic risks, and careful management of immunosuppressive therapies to reduce infectious complications. A multidisciplinary and individualized therapeutic strategy remains essential in managing such complex autoimmune overlap syndromes.

کلیدواژه ها:

Antiphospholipid syndrome ، systemic lupus erythematosus ، Secondary APS ، anticoagulation ، Hypoxemia ، antiphospholipid antibodies