Thrombotic antiphospholipid syndrome in a child with human immunodeficiency virus: a rare case report

Pediatric antiphospholipid syndrome: is it the same as an adult?

IMPORTANCE

Antiphospholipid syndrome in neonates and children is a rare, but in some cases life-threatening condition with arterial and/or venous thrombosis and/or non-thrombotic neurological, skin, ophthalmological and other manifestations.

OBSERVATIONS

This review highlights the available information about the features of pediatric APS, including the rare catastrophic form, the differences between pediatric and adult APS, and the role of genetic thrombophilia in APS manifestation.

CONCLUSIONS AND RELEVANCE

The clinical manifestations and treatment options for APS in children may differ from those in adults, and prescribing therapy can be challenging due to the unique clinical and morphological characteristics of the pediatric patient. Pediatric APS may be a predictor of the development of certain autoimmune diseases and classic manifestations of APS in adulthood, therefore, a revision of the existing criteria for the diagnosis and treatment of APS in children is necessary.

A Case of Deep Venous Thrombosis in an HIV-Infected Patient despite Therapeutic Anticoagulation

Patients with human immunodeficiency virus (HIV) infection have an increased likelihood of venous thromboembolism (VTE) owing to factors such as acquired protein C and S deficiency, antiphospholipid antibody syndrome, and heightened levels of pro-inflammatory cytokines. This case report highlights an exceptionally uncommon occurrence of deep venous thrombosis in an HIV-infected patient receiving a therapeutic dose of enoxaparin. This underscores the need for cautious consideration of the risk of VTE in HIV-infected individuals, even with preventive or therapeutic anticoagulant treatment. Further research is recommended to investigate HIV as a potential risk factor of prophylactic anticoagulation.

Hepatitis-A Infection-Induced Secondary Antiphospholipid Syndrome With Neuro-ophthalmological Manifestations

Antiphospholipid syndrome (APS) is a multisystem autoimmune disorder that can affect children and adults alike, with a similar spectrum of thrombotic events, predominately deep vein thrombosis and stroke. It is characterized by recurrent arterial or venous thrombosis and recurrent fetal loss with the presence of antiphospholipid antibodies (aPL) like antibodies to beta-2-glycoprotein I (B-2-GPI) and anticardiolipin (aCL). The disease could be classified into primary APS in the absence of an underlying disease or secondary APS occurring secondary to autoimmune diseases, infections, malignancies, and sometimes medication use. In the absence of clinical manifestations of APS, transient non-thrombogenic antiphospholipid antibodies are seen more commonly in children, predominantly after childhood infections. Cases with clinical manifestations of APS associated with different types of infections have been reported in the literature to keep track of potential triggering causes and take measures to prevent or treat the disease manifestations. This case documents the case of hepatitis-A as a triggering viral infection, causing secondary APS in a child.