Bilateral Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome during Chronic Graft-versus-host Disease

We present the case of a 56-year-old man with an upper respiratory infection followed by fatigue, hypotension, and hyponatremia. Bilateral adrenal hemorrhage was confirmed, based on T2-weighted magnetic resonance imaging. The patient had previously undergone allogeneic hematopoietic stem cell transp...

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Bibliographic Details
Published in:Internal Medicine 2018/05/15, Vol.57(10), pp.1439-1444
Main Authors: Minami, Mariko, Muta, Tsuyoshi, Adachi, Masahiro, Higuchi, Masakazu, Aoki, Kenichi, Ogawa, Ryosuke
Format: Article
Language:English
Subjects:
Adrenal Gland Diseases - diagnostic imaging
Adrenal Gland Diseases - drug therapy
Adrenal glands
adrenal hemorrhage
Adrenal Insufficiency - diagnosis
Anticoagulants - therapeutic use
antiphospholipid antibody syndrome
Antiphospholipid syndrome
Antiphospholipid Syndrome - diagnosis
Antiphospholipid Syndrome - drug therapy
Case Report
Diagnosis
Fatigue
Fatigue - diagnosis
Graft vs Host Disease - diagnosis
graft-versus-host disease
Graft-versus-host reaction
Hematopoietic stem cells
Hemorrhage
Hemorrhage - diagnostic imaging
Hemorrhage - drug therapy
Humans
Hyponatremia
Hyponatremia - diagnosis
Hypotension
Hypotension - diagnosis
Internal medicine
Magnetic Resonance Imaging
Male
Middle Aged
Respiratory Tract Infections - diagnosis
Stem cell transplantation
Transplantation
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Summary:We present the case of a 56-year-old man with an upper respiratory infection followed by fatigue, hypotension, and hyponatremia. Bilateral adrenal hemorrhage was confirmed, based on T2-weighted magnetic resonance imaging. The patient had previously undergone allogeneic hematopoietic stem cell transplantation and had been diagnosed with antiphospholipid syndrome (APS) during the development of chronic graft-versus-host disease. A prompt diagnosis and steroid replacement, in addition to anticoagulant therapy, resulted in a favorable outcome. Once the diagnosis of APS has been confirmed, which might be the sign of bilateral adrenal hemorrhage, the initial manifestations of adrenal insufficiency should never be overlooked.
ISSN:0918-2918
1349-7235
1349-7235
DOI:10.2169/internalmedicine.9820-17