SPONTANEOUS BILATERAL ADRENAL HEMORRHAGE AS MANIFESTATION OF PRIMARY ANTIPHOSPHOLIPID ANTIBODY SYNDROME

A CASE REPORT

Abstract

CASE
A 31-year-old Filipino female presented with epigastric tenderness. She had anemia, thrombocytopenia, hyponatremia, and elevated D-dmer. An initial CT scan ofthe abdomen showed left adnexal fluid. Due to worsening of symptoms, a mesenteric CT angiogram was done revealing a left adrenal gland hematoma. Adrenal function was shown to be normal but she was started on hydrocortisone. An emergency adrenal angiogram was done revealing extravasation of dye from the inferior, superior, and middle adrenal arteries. A superselective adrenal arterial embolization was performed which resulted in a dramatic decrease in dye extravasation. Post-procedure, the patient developed a fever and dyspnea. On chest x-ray, there was a sudden increase in cardiac size. She was given a dose of methylprednisolone pulse therapy for possible SLErelated pericardial effusion. Blood specimen was sent for ANA, anti-DsDNA, and anti-cardiolipin studies revealing positive results. She eventually improved with tapering doses of prednisone and hydroxychloroquine.