Antiphospholipid syndrome with acute myocardial infarction and portal veils occlusion - A case report

A 62-year-old woman was admitted to hospital because of chest oppression an d abdominal discomfort. Coronary arteriography revealed that the proximal l eft anterior descending artery had a large thrombus with TIMI (Thrombolysis in Myocardial Infarction) Grade 3 flow. On the second hospital day, she ha d sudden hematemesis because of esophageal varices. Her general condition b ecame stable with conventional therapy. On the 20th hospital day, coronary arteriography and arterial portography showed that the thrombus had diminis hed. Arterial portography also revealed total occlusion of the portal vein as well as giant gastric varices. She was diagnosed as antiphospholipid syn drome, based on the presence of lupus anticoagulant. The treatment of this case was very complicated because of the bleeding from the esophageal varic es induced by the anticoagulant therapy for the thrombus, Prednisolone was administered for 1 month, but no remarkable effects were observed. Therefor e, she was treated with endoscopic sclerotherapy for the esophageal varices and anticoagulant therapy for prevention of thrombosis.