Case 1 is a woman who was referred for pregnancy counselling in 1993 (age 29 years). She had antiphospholipid syndrome (APS) based on a history with DVT, 2 early spontaneous abortions and positive serology. There was obesity (BMI 40,5), livedo reticularis, hypertension and renal insufficiency. Antinuclear, anti-dsDNA, anticardiolipin antibodies (IgG) and Lupus anticoagulant were present. Renal biopsy showed mesangioproliferative changes with ischemia and vascular abnormalities compatible with malignant hypertension. Treatment with aspirin and antihypertensive drugs was started. In 1995 she had an ischemic stroke with aphasia. Aspirin was replaced by oral anticoagulants. Five months later she developed glomerulonephritis (biopsy: mesangioproliferative glomerulonephritis) and treatment with high dose prednisone was started. In 2001 she had a proximal DVT despite adequate anticoagulation (INR 4.7), followed by subdural and subarachnoidal cerebral bleeding. Shortly after this episode recurrent DVT occurred. Treatment with oral anticoagulants was stopped and continuous anticoagulation with LMWH was given. After 7 years on this treatment she had another ischemic cerebral infarction. Aspirin was added to the medications. Over the last few years no recurrent thrombosis occurred. Points for discussion will be renal manifestations and treatment of thrombotic APS.
Case 2 is a woman diagnosed in 1995 with SLE (arthritis, SCLE, antinuclear, anti-dsDNA and antiSm-Ab) at age 24. In 2003 she give birth to a healthy daughter after an uncomplicated pregnancy. Seven years later she suddenly experienced episodic visual complaints, transient difficulties with speaking and headaches. Platelet count: 10.109/L. Points for discussion: differential diagnosis of thrombocytopenia in SLE.
Disclosure of Interest None Declared
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