Sequential Splenic and Cerebral Infarctions Revealing Triple-Positive Antiphospholipid Antibodies in an Adolescent with Systemic Lupus Erythematosus: A Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Antiphospholipid antibodies (aPL) are an important cause of arterial thrombosis in systemic lupus erythematosus (SLE), yet visceral involvement such as splenic infarction is uncommon and can be overlooked when abdominal symptoms arise during active disease. Case Presentation: A 14-year-old girl with newly diagnosed, poorly controlled SLE presented with fever, mucocutaneous disease, anaemia and thrombocytopenia. On a subsequent admission for acute abdominal pain, contrast-enhanced CT revealed a peripheral splenic infarct without mesenteric ischaemia or thrombosis. The next day she developed right upper-limb weakness on awakening, and brain CT confirmed an acute infarct of the left caudate nucleus and anterior limb of the internal capsule — two arterial territories affected within roughly 24 hours. Work-up revealed a triple-positive aPL profile (anticardiolipin antibodies, lupus anticoagulant and anti-β2-glycoprotein I antibodies), a positive direct antiglobulin test with features of autoimmune haemolysis, and a rise in SLEDAI-2K from 6 to 16. She improved with corticosteroids, hydroxychloroquine and antithrombotic therapy, and the platelet count recovered. On follow-up testing, anticardiolipin IgG/IgM and anti-β2-glycoprotein I IgG remained positive, while the lupus anticoagulant was now absent. Conclusion: This case illustrates how rapid, multisite arterial thrombosis can develop in an adolescent with SLE and triple-positive aPL, and underscores that acute abdominal pain in this setting may signal visceral infarction warranting prompt evaluation for aPL-associated thrombosis — particularly when active disease and thrombocytopenia coexist.
Author: Jaisuriya Rajendiran
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7213743033