Abstract Details

Title Blood, Heart, and Mind: A Case of Lymphoma-Triggered Antiphospholipid Syndrome Leading to Recurrent Embolic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-008

Objective To present a case of multifocal cortical embolic infarcts with pancytopenia, being eventually diagnosed with Nonbacterial thrombotic endocarditis (NBTE) secondary to antiphospholipid syndrome (APLA), emphasizing the importance of being cognizant to different hematological causes of embolic stroke of unknown etiology (ESUS).

Background APLA is a potential hypercoagulable pathology causing venous and arterial thromboembolism cerebral infarctions. Arterial stroke due to APLA might be due to in situ thrombosis or NBTE. In stroke patients with underlying malignancies or suspected hypercoagulable conditions, APLA can complicate the diagnostic process

Design/Methods NA

Results A 60-year-old female with a history of pancytopenia, type 2 diabetes, and recurrent strokes (2 years ago and 2 months ago, both labeled as ESUS) presented with generalized weakness and recurrent falls. During her recent admission for stroke, she was diagnosed to have splenic marginal zone lymphoma by bone marrow biopsy. Her neurological exam revealed confusion, left-sided weakness, and encephalopathy. Initial stroke work up, including CT angiography, A1C, LDL, rhythm monitoring, and TTE were all negative. Patient continued to worsen clinically, and repeat MRI confirmed new multifocal embolic cortical strokes. LP was performed to rule out possible intravascular lymphoma. CSF analysis was normal and negative flow cytometry. TEE revealed a mitral leaflet mass. Comprehensive infectious work up came back negative, but coagulopathy workup was notable for triple-positive APLA (anticardiolipin, beta2 glycoprotein, hex lupus anticoagulant), which was deemed to cause the stroke through NBTE, and projected to be secondary to marginal zone lymphoma.

Conclusions

The prevalence of APLA in the normal population range from 1% to 5.6%, in newly diagnosed lymphoma, APLA prevalence was 37.5%. Lymphoma triggers APLA by either direct synthesis or immune mediated. This case underscores the importance of performing thorough, yet targeted work up for ESUS patients, especially if recurrent.

Authors/Disclosures
Mohammed Qussay Ali Al-Sabbagh, MD (University of Kansas Medical Center) PRESENTER	Dr. Al-Sabbagh has nothing to disclose.
Prasanna Venkatesan Eswaradass, MD (University of Kansas Health System)	Dr. Eswaradass has nothing to disclose.
Aliya Rashid, DO	Dr. Rashid has nothing to disclose.
Arpan Patel, MBBS (University of Kansas Medical Center)	Dr. Patel has nothing to disclose.

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