Dr Aibek E Mirrakhimov at Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA and colleagues have reported a serious case of Antiphospholipid syndrome mimicking a benign Panic disorder that appeared in BMJ.
Antiphospholipid syndrome (APS) is an acquired autoimmune disorder that manifests clinically as recurrent venous or arterial thrombosis and/or fetal loss. It is present in 15 – 20% of all cases of deep vein thrombosis and in one-third of new strokes occurring in people under the age of 50.
According to history, a 27-year-old, non-obese, non-smoker Caucasian woman with no medical history came to the emergency department, because of vague chest discomfort, shortness of breath and palpitations. Her family history was significant only for lung cancer in her father at age 72. ECG showed sinus tachycardia with a rate of 112/min; chest x-ray did not show any evidence of pulmonary or chest pathology. Troponins came back negative. The patient denied using medications and recreational drugs. The patient was presumed to have a panic attack and clonazepam was administered, with the resolution of her symptoms within 1 h.
Two weeks later the patient was hospitalised, because of chest pain, shortness of breath and light-headedness. D-dimers came elevated, and CT scan of the chest with contrast showed filling defects in the main posteromedial basal segmental branch of the left lower lobe pulmonary artery and posterior basal segmental branch of the right lower lobe pulmonary artery.
The patient was treated with low molecular weight heparin, with a switch to oral warfarin. Lower extremity Doppler ultrasound did not detect any evidence of thrombosis. After a thorough laboratory workup, the patient was found to have anticardiolipin antibodies, with confirmation 3 months later. The patient agreed to use warfarin indefinitely.
Panic disorder usually presents in a young woman and may mimic diseases with a more ominous prognosis. Antiphospholipid syndrome is notorious for a propensity for clotting and is considered to be a risk factor for pulmonary embolism and pulmonary disorders.
- Panic disorder may mimic a disease with more ominous prognosis Antiphospholipid syndrome, due to non-specific symptomatology.
- In Antiphospholipid syndrome, risk factors for thrombosis must be addressed. These include diabetes, hypertension or high blood pressure, hypercholesterolemia or high cholesterol, obesity, smoking, estrogen therapy for menopause or contraception, and any underlying systemic autoimmune disease.
- The clinicians should have a low threshold for pursuing a further work-up for pulmonary embolism in young patients presenting with chest discomfort, anxiety and shortness of breath.
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