Retinal vein and artery occlusion as the first manifestation of primary antiphospholipid syndrome in a pediatric patient

ABSTRACT Antiphospholipid syndrome is an acquired autoimmune disease characterized by hypercoagulability associated with recurrent venous and arterial thromboembolism in the presence of antiphospholipid antibodies. Herein, we report a case of rapid sequential retinal vein and artery occlusion as the first manifestation of a primary antiphospholipid syndrome triggered by an acute Mycoplasma infection in a previously healthy 11-year-old patient. On day 1, ophthalmoscopy revealed a central retinal vein occlusion. The patient developed temporal branch retinal artery occlusion the next day. On day 3, a central retinal artery occlusion was observed. Serum lupus anticoagulant, immunoglobulin (Ig) G anticardiolipin, IgG anti-β2-glycoprotein 1 antibody, and Mycoplasma pneumoniae IgM antibody levels were increased. Thus, retinal vascular occlusions can be the first manifestation of primary antiphospholipid syndrome. Although it may not improve visual prognosis, prompt diagnosis and treatment are essential to avoid further significant morbidity.

【摘要】 抗磷脂综合征（antiphospholipid syndrome）是一类以高凝状态为特征的获得性自身免疫性疾病，患者常伴随复发性静脉与动脉血栓栓塞，且体内可检出抗磷脂抗体。本文报告1例以快速序贯性视网膜静脉及动脉阻塞为首发表现的原发性抗磷脂综合征病例：该病例由急性支原体感染诱发，患者为既往体健的11岁儿童。入院第1天，眼底镜检查可见视网膜中央静脉阻塞；次日患者出现视网膜颞侧分支动脉阻塞；第3天确诊视网膜中央动脉阻塞。实验室检测结果显示，患者血清狼疮抗凝物、免疫球蛋白G（IgG）抗心磷脂抗体、IgG抗β2糖蛋白1抗体及肺炎支原体IgM抗体水平均升高。综上，视网膜血管阻塞可作为原发性抗磷脂综合征的首发临床表现。尽管此类情况未必能改善患者的视觉预后，但及时诊断与治疗对避免进一步严重并发症至关重要。