A clinical case report: stroke in a young patient with systemic lupus erythematosus on the background of secondary antiphospholipid syndrome

Abstract

The article describes a clinical case report of a young patient with ischemic stroke on the background of antiphospholipid syndrome (APLS). The uniqueness of this case lies in the complex diagnostic search that we performed. On admission, the patient had general cerebral, general infectious and focal syndromes. We suspected encephalitis due to the peculiarities of the onset of the disease and the results of computed tomography. However, after the results of lumbar puncture, the diagnosis of encephalitis required careful differential diagnosis. We performed an extensive diagnostic search. Based on clinical-laboratory, instrumental and immunological data the patient had the following final diagnosis: “Ischemic cardioembolic stroke in the right middle cerebral artery pool (15.10.17) (ICD 11: 8B11.5). Acute period with left pyramidal reflex insufficiency and changes in magnetic resonance imaging. Systemic lupus erythematous (ICD 11: 4A40.0), subacute course, activity II, with the lesion of skin (transient erythematous rash), kidneys (proteinuria, transient impaired renal function), lungs (bilateral pleurisy with immunological disorders). Secondary APLS (ICD 11: 4A45) (Acute iliofemoral thrombosis, May 2017; chronic thrombosis of the inferior vena cava, iliac veins, positive IgG to cardiolipin, beta 2 glycoproteins). Thus, we have to link thrombotic complications in young patients with APLS and to examine the patients for antiphospholipid antibody presence.

Keywords

• antiphospholipid syndrome
• ischemic stroke
• antiphospholipid antibodies