Postpartum Hepatic Infarction in Antiphospholipid Syndrome Patients

Abstract

CASE: Our patient is a 31-year-old woman with a complicated past medical history of Systemic Lupus Erythematosus (SLE) and Antiphospholipid Ayndrome (APS). She originally presented several years ago when she was found to have Libman-Sacks endocarditis. She was diagnosed with SLE and APS at the time and was subsequently anticoagulated with warfarin. When she became pregnant, warfarin was discontinued and she was managed with a low molecular weight heparin (LMWH). She was continued on LMWH post-partum, but was noncompliant. For a few weeks following delivery, she presented to the hospital on several occasions with acute right upper quadrant pain. CT imaging confirmed several hepatic infarcts and she was treated with steroids, fondaparinux, and plaquenil. CONCLUSIONS: APS poses several risks during and after pregnancy due to susceptibility to venous and arterial thrombosis1. There is an increased risk of thrombosis up to 12 weeks postpartum. Continuation of anticoagulation following delivery is essential in APS women who have a high baseline risk of thrombosis2. Non-compliance with medications may have contributed to this presentation. This case is unique in that hepatic infarcts rarely occur due to the dual blood supply of the liver. Moreover, the diagnosis of hepatic infarction can be difficult as it may present similarly to HELLP, possibly contributing to her multiple admissions with RUQ pain3,4. CLINICAL SIGNIFICANCE: This case is significant because it demonstrates the rare, but life-threatening risk of postpartum hepatic infarction in APS patients. Proper postpartum management and compliance with anticoagulation medications are essential to mitigating risk. Furthermore, providers may face challenges in diagnosing hepatic infarction as it could mimic other diseases.