L’obstruction urétérale non lithiasique inaugurale d’une maladie de Crohn : une complication rare et méconnue

Noncalculous ureteral obstructions in Crohn??s disease are rare (3% in inflammatory bowel disease). They often are asymptomatic and unidentified. They are secondary to inflammation and fibrosis. Treatment could be medical or surgical. We report the case of a patient with non calculous ureteral obstruction revealing Crohn??s disease.     

Hémorragie bilatérale des surrénales sous apixaban dans le syndrome primaire des antiphospholipides

Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome.We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in 53-year-old women treated by apixaban for previous venous thromboembolism.     

Nécrose hémorragique bilatérale des surrénales sous apixaban : penser au syndrome des antiphospholipides ?

IntroductionAdrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome.Case reportWe present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism.ConclusionTo our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.