Antiphospholipid Antibody Syndrome

CASE PRESENTATION

At the age of 15 years, 4 years before consultation, a white woman had a sudden onset of right hemiplegia. High-titer immunoglobulin G (IgG) and immunoglobulin M (IgM) antiphospholipid antibody and lupus anticoagulant were found, and prednisone, 60 mg/d, and aspirin, 325 mg/d, were prescribed. Prednisone was discontinued after 1 year. At the age of 18 years, mild proteinuria, arthralgia, and chorea developed, and after magnetic resonance imaging, were attributed to a new stroke. The patient became pregnant for the first time at the age of 19 years and developed urinary protein (2 g/d) without hypertension at 14 weeks. Prednisone, aspirin, and heparin were administered, but because of a rise of blood pressure to 160/ 90 mm Hg, an increase in urinary protein to 10 g/d, and vaginal bleeding, a cesarean section was performed at 28 weeks and a boy weighing 680 g was delivered. While taking heparin