The Indian Practitioner

A. Rajadhyaksha ¹, N. S. Sarate ¹

Affiliations
1 Department of Medicine, Seth G.s. Medical College & Kem Hospital, Parel, Mumbai, IN

Abstract

In recent years, the association between infection&anti-phospholipid antibody syndrome have been reported in several epidemiologic&experimental studies that support the idea of infectious induction of Anti-phospholipid Syndrome.(1)(2) Herein we report 72 yr premorbidly healthy male presented with P.vivax malaria with multi-organ dysfunction syndrome with ARDS. On 6^th day of admission, he developed left side hemiplegia. MRI+MRA (BRAIN) showed Right ACA territory infarct&thrombosed right common&internal carotid artery thrombosis. Autoimmune work-up showed ACLA IgM; APLA IgM; β2-glycoprotein-1 IgM were highly significant titre [58.9 MPL/ml,58.3 U/ml,113.9 RU/ml respectively]. Infections like malaria triggering Anti-phospholipid antibody Syndrome has been described in paediatric age groups. So Plasmodium vivax malaria with hepatic involvement with ARDS with common&internal carotid thrombosis due to secondary APLA Syndrome in geriatric age group is very unusual presentation. We managed this patient with anti-malarials, supportive therapy, anti-coagulation with heparin followed by warfarin overlap with PT/INR monitoring.

Keywords

P.Vivax Malaria, Anti-Phospholipid Antibody Syndrome, Carotid Artery Thrombosis.

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A. Rajadhyaksha ¹, N. S. Sarate ¹, Y. Kuntalwad ¹

Affiliations
1 Department of Medicine, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, IN

Abstract

Eosinophilia is uncommon phenomenon in patients with rheumatoid arthritis. It either reflects active rheumatoid arthritis or drug reaction.⁽⁴⁾ We describe a case of rheumatoid arthritis who was previously seronegative, presented with symmetrical polyarthritis . After starting treatment patient became seropositive for RF and anti-ccp antibody along with significant eosinophilia. Patient was treated as RA flare with eosinophilia and seroconversion(6) with T. Methotrexate 15mg/wk, T.HCQ 300 mg HS, NSAIDS and low dose T.prednisolone. Patient was advised to follow up with CBC,ESR,CRP, RA&Anti-CCP antibody. Follow up reports showed improvement.

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