系统性红斑狼疮(SLE)主要影响年轻女性,并与血栓形成风险增加有关。抗磷脂抗体综合征(APS)可能会使临床表现复杂化,常导致动静脉血栓复发。此病例报告强调了两个独特方面的重要性:罕见的心房血栓发生和抗核抗体(ANA)阴性SLE的存在。
■一名32岁女性,有对称性多关节疼痛史,口腔溃疡,显著的体重减轻,无缘无故的pop血栓形成和两次原因不明的流产史。入院前一周,她经历了严重的头痛和血压升高。临床评估显示几个异常,包括收缩期杂音,网状livedo,经胸超声心动图显示严重的二尖瓣反流和心房血栓。经食道超声心动图证实右心房存在带蒂病变,具有挑战性的鉴别诊断。
■ANA阴性SLE,虽然罕见,在这个病人身上观察到,突出诊断的复杂性。APS加重了临床表现,强调识别特异性自身抗体和复发性血栓事件的重要性。在心房血栓的情况下,与其他心脏病的区别,如粘液瘤或植被,是一把钥匙。
■此案例强调了识别和管理心房血栓的重要性,系统性红斑狼疮和抗磷脂综合征患者的一种罕见但危及生命的并发症。此外,ANA阴性SLE的诊断挑战值得在具有疾病特征性特征的患者中仔细考虑.
UNASSIGNED: Systemic lupus erythematosus (SLE) predominantly affects young women and is associated with an increased risk of thrombosis. Antiphospholipid antibody syndrome (APS) may complicate the clinical picture, often leading to recurrent arteriovenous thrombosis. This
case report underscores the significance of two unique aspects: the rare occurrence of an atrial thrombus and the presence of antinuclear antibody (ANA)-negative SLE.
UNASSIGNED: A 32-year-old woman presented with a history of symmetric polyarticular joint pain, oral ulcers, significant weight loss, and a history of unprovoked popliteal thrombosis and two unexplained abortions. One week prior to admission, she experienced severe headaches and elevated blood pressure. Clinical evaluation revealed several abnormalities, including a systolic murmur, livedo reticularis, and a transthoracic echocardiogram showing severe mitral regurgitation and an atrial thrombus. A transesophageal echocardiogram confirmed the presence of a pedunculated lesion in the right atria, challenging differential diagnosis.
UNASSIGNED: ANA-negative SLE, though rare, was observed in this patient, highlighting diagnostic complexities. APS compounded the clinical presentation, emphasizing the importance of identifying specific autoantibodies and recurrent thrombotic events. In the
case of atrial thrombus, differentiation from other cardiac conditions, such as myxoma or vegetation, is a key.
UNASSIGNED: This
case underscores the critical importance of recognizing and managing atrial thrombus, a rare but life-threatening complication in patients with systemic lupus erythematosus and antiphospholipid syndrome. Additionally, the diagnostic challenge of ANA-negative SLE warrants careful consideration in patients presenting with characteristic features of the disease.