Epidural hematoma mimicking transverse myelitis in a patient with primary antiphospholipid syndrome |
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Authors: | W J Kim Y K Hong Wan-Hee Yoo |
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Institution: | (1) Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, #634-18, Geumam-Dong, Deokjin-Gu, Jeonju, Chonbuk, 561-712, South Korea |
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Abstract: | Antiphospholipid syndrome (APS) is an autoimmune disease, and its most critical pathologic process is thrombosis, which may
explain most of the clinical features. Acute management of thrombosis involves immediate anticoagulation. Acute proximal venous
thrombosis can be managed with thrombolytic therapy to reduce the long-term complications of the postthrombotic syndrome (pain,
swelling, skin discoloration, or ulceration) and perform recanalization of occluded vessels. However, thrombolytic therapies
are associated with high risks of bleeding. To our knowledge, this is the first report of epidural hematoma mimicking transverse
myelitis after catheter-directed thrombolysis in a patient with primary APS. A 42-year-old male was admitted with sudden onset
pain and swelling on left lower extremity. Venography demonstrated multiple thrombi on superficial femoral vein, common femoral
vein, common iliac vein, and external iliac vein. Laboratory tests indicated the presence of IgM anticardiolipin antibody.
He was diagnosed with primary APS with multiple venous thrombi. He was treated with urokinase (200,000/h) as thrombolytic
therapy. After 1 day, he complained both leg weakness and urinary dysfunction. T1- and T2-weighted magnetic resonance images
of spine showed about 8 cm-sized mass, suggesting hematoma on the posterior epidural space at thoracolumbar area. Despite
the successful evacuation of hematoma, neurologic symptoms persisted and he is now receiving aspirin, warfarin, and physical
therapy. |
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Keywords: | Antiphospholipid syndrome Hematoma Thrombolytic therapy Transverse myelitis |
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