J Rheum Dis.  2016 Apr;23(2):118-121. 10.4078/jrd.2016.23.2.118.

A Case of Azygos Vein Thombosis Associated with Transient Antiphospholipid Syndrome in Urinary Tract Infection with Escherichia coli

• Lee HJ
• Kang YM
• Lee E
• Jeong BJ
• Jo YJ
• Seong JS
• Woo YM
• Jeong KH

• KMID: 2222788
• DOI: http://doi.org/10.4078/jrd.2016.23.2.118

Abstract

A 73-year-old female with diabetes admitted for treatment of an intertrochanter fracture of the femur and a urinary tract infection (UTI) with Escherichia coli developed thrombosis in her right azygos vein, which was thought to be associated with antiphospholipid and immunoglobulin M anticardiolipin antibodies. After antibiotic therapy, antiphospholipid antibody was undetectable, and a repeat chest computed tomography showed complete resolution of the azygos vein thrombosis. A wide variety of infections can be associated with thrombotic events in patients with transient antiphospholipid syndrome (APS), and this case serves as a reminder that the possibility of transient APS should be considered in patients with venous thrombosis in the setting of a UTI.

Keyword

Antiphospholipid syndrome; Urinary tract infections; Escherichia coli

MeSH Terms

Aged
Antibodies, Anticardiolipin
Antibodies, Antiphospholipid
Antiphospholipid Syndrome*
Azygos Vein*
Escherichia coli*
Escherichia*
Female
Femur
Humans
Immunoglobulin M
Thorax
Thrombosis
Urinary Tract Infections*
Urinary Tract*
Venous Thrombosis
Antibodies, Anticardiolipin
Antibodies, Antiphospholipid
Immunoglobulin M

Figure

• 

  Figure 1. Contrast enhanced chest computed scan, axial image at pulmonary trunk bifurcation and coronal reformation, showed filling defects in the azygos vein (arrows).

• 

  Figure 2. Follow-up of chest computed tomography revealed complete resolution of the embolism in the azygos vein (arrows).

Reference

1. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002; 46:1019–27.

2. Cervera R, Asherson RA, Acevedo ML, Gómez-Puerta JA, Espinosa G, De La Red G, et al. Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics of 100 patients. Ann Rheum Dis. 2004; 63:1312–7.

3. Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bed-side without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001; 135:98–107.

4. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4:295–306.

5. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002; 346:752–63.

6. Misita CP, Moll S. Antiphospholipid antibodies. Circulation. 2005; 112:e39–44.

7. Dalekos GN, Zachou K, Liaskos C. The antiphospholipid syndrome and infection. Curr Rheumatol Rep. 2001; 3:277–85.

8. Asherson RA, Cervera R. Antiphospholipid antibodies and infections. Ann Rheum Dis. 2003; 62:388–93.

9. Ioannou Y, Giles I, Lambrianides A, Richardson C, Pearl LH, Latchman DS, et al. A novel expression system of domain I of human beta2 glycoprotein I in Escherichia coli. BMC Biotechnol. 2006; 6:8.

10. Cicconi V, Carloni E, Franceschi F, Nocente R, Silveri NG, Manna R, et al. Disappearance of antiphospholipid antibodies syndrome after Helicobacter pylori eradication. Am J Med. 2001; 111:163–4.

11. Blank M, George J, Fishman P, Levy Y, Toder V, Savion S, et al. Ciprofloxacin immunomodulation of experimental anti-phospholipid syndrome associated with elevation of interleukin-3 and granulocyte-macrophage colony-stimulating factor expression. Arthritis Rheum. 1998; 41:224–32.

12. Kang WS, Min JW, Park SJ, Lee MK, Park CS, Chung JH. A case of septic azygos vein embolism caused by staphylococcus aureus bacteremia. Tuberc Respir Dis (Seoul). 2012; 72:328–31.

13. Okur A, Intepe YS, Serin HI, Yı ldı rım U, Mavili E. Recurrent pulmonary embolism in an asthmatic patient who had inter-rupted inferior vena cava with azygous continuation. Turk Kardiyol Dern Ars. 2014; 42:277–80.

14. Hellfritzsch MB. General anatomy and musculoskeletal system. Acta Radiol. 2015; 56:NP24.

15. Vallianou N, Lazarou V, Tzangarakis J, Barounis R, Sioula E. Pulmonary embolism as the first manifestation of multiple myeloma. Case Rep Med. 2013; 2013; 236913.