Letter to the Editor
Humeral Artery Thrombosis Simulating an Elbow Monoarthritis in a Woman With Primary Antiphospholipid Syndrome (Hughes Syndrome)
Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes)
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array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan José" "apellidos" => "Alegre Sancho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José" "apellidos" => "Ivorra Cortés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "José Miguel" "apellidos" => "Zaragozá García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Universitario Dr. Peset, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Vascular, Hospital Universitario Dr. Peset, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 785 "Ancho" => 900 "Tamanyo" => 80797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of humeral artery thrombosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Antiphospholipid syndrome is defined as a hypercoagulability state with episodic arterial or venous thrombosis and recurrent fetal loss in the presence of antiphospholipid antibodies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Arterial thrombosis is less common than venous thrombosis and peripheral arteries are only affected in 25% of events.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Among the peripheral arterial thrombosis, upper limbs are only affected in 2.7% of cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a patient with left humeral artery thrombosis and antiphospholipid syndrome, who presented with atypical symptoms. The patient, a 66-year-old woman with a history of smoking (30 packs/year) and with mild hypertriglyceridemia, came to the clinic due to urgent pain, swelling and functional impairment of the left elbow which began acutely seven days prior, associated with a decrease in the hand on the same side, with no fever or other clinical manifestations. Upon examination we found a swollen and functionally limited elbow (flexion 40°) with erythema and increased local temperature. The fingers felt cold and there was a reduction in the radial pulse compared to the contralateral side, but with good capillary flow. Laboratory analysis showed: CRP 115<span class="elsevierStyleHsp" style=""></span>mg/dl; D dimer 469<span class="elsevierStyleHsp" style=""></span>ng/ml; fibrinogen 550<span class="elsevierStyleHsp" style=""></span>mg/dl; leucocytes 13.4×10<span class="elsevierStyleSup">9</span>/l (10.8×10<span class="elsevierStyleSup">9</span>/l). An echographic study was performed ruling out joint affection but showing the existence of a hypoechoic, heterogeneous thickening of the extensor-supinator muscles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A Doppler study showed an occlusion of the humeral artery at the elbow flexure. Vascular surgeons, who began treatment with cilostazole, low molecular weight heparin and aspirin, confirmed these findings. When searching for the underlying cause we found the presence of positive lupus anticoagulant in two separate determinations 3 months apart, with negative anticardiolipin and anti-b2-glucoprotein 1 antibodies. With the diagnosis of thrombosis of the humeral artery in the context of antiphospholipid syndrome we recommended oral anticoagulation with acenocoumarin, with a good progression.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Acute arterial thrombosis is the sudden interruption of blood supply due to the obstruction of the artery that irrigates a specific territory, due to prior stenosis or the existence of an aneurysm at that level, generally having a precipitating factor (hypercoagulability, low cardiac output, etc.). It is clinically manifested as intense pain, pallor, coldness and loss of distal strength, with abolished distal pulse. In our patient, in addition to the poor frequency with which humeral artery occurs, most of the typical signs of acute arterial thrombosis were absent and rather simulated an acute elbow arthritis. When reviewing the literature we have only found descriptions of pain and impairment of the elbow when humeral artery thrombosis is associated to suprachondileal fractures,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> as opposed to our case.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Feced Olmos CM, Alegre Sancho JJ, Ivorra Cortés J, Zaragozá García JM. Trombosis de la arteria humeral simulando una monoartritis de codo en una paciente con síndrome antifosfolipídico primario (síndrome de Hughes). Reumatol Clin. 2014;10:135–136.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 785 "Ancho" => 900 "Tamanyo" => 80797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of humeral artery thrombosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "APhL antibody ELISA as an alternative to anticardiolipin test for the diagnosis of antiphospholipid syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.B. 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| 2021 April | 137 | 61 | 198 |
| 2021 March | 73 | 15 | 88 |
| 2021 February | 31 | 17 | 48 |
| 2021 January | 37 | 17 | 54 |
| 2020 December | 38 | 22 | 60 |
| 2020 November | 29 | 17 | 46 |
| 2020 October | 36 | 8 | 44 |
| 2020 September | 72 | 27 | 99 |
| 2020 August | 76 | 16 | 92 |
| 2020 July | 50 | 16 | 66 |
| 2020 June | 33 | 21 | 54 |
| 2020 May | 25 | 8 | 33 |
| 2020 April | 23 | 17 | 40 |
| 2020 March | 16 | 13 | 29 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 34 | 16 | 50 |
| 2018 March | 59 | 21 | 80 |
| 2018 February | 18 | 9 | 27 |
| 2018 January | 19 | 10 | 29 |
| 2017 December | 16 | 9 | 25 |
| 2017 November | 20 | 13 | 33 |
| 2017 October | 19 | 3 | 22 |
| 2017 September | 16 | 4 | 20 |
| 2017 August | 17 | 8 | 25 |
| 2017 July | 22 | 14 | 36 |
| 2017 June | 39 | 10 | 49 |
| 2017 May | 55 | 13 | 68 |
| 2017 April | 37 | 7 | 44 |
| 2017 March | 30 | 23 | 53 |
| 2017 February | 12 | 7 | 19 |
| 2017 January | 29 | 7 | 36 |
| 2016 December | 58 | 28 | 86 |
| 2016 November | 38 | 17 | 55 |
| 2016 October | 49 | 22 | 71 |
| 2016 September | 73 | 25 | 98 |
| 2016 August | 81 | 37 | 118 |
| 2016 July | 38 | 23 | 61 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 18 | 4 | 22 |
| 2015 June | 20 | 20 | 40 |
| 2015 May | 44 | 59 | 103 |
| 2015 April | 24 | 37 | 61 |
| 2015 March | 27 | 19 | 46 |
| 2015 February | 28 | 33 | 61 |
| 2015 January | 64 | 37 | 101 |
| 2014 December | 39 | 27 | 66 |
| 2014 November | 28 | 30 | 58 |
| 2014 October | 29 | 43 | 72 |
| 2014 September | 21 | 39 | 60 |
| 2014 August | 25 | 27 | 52 |
| 2014 July | 40 | 34 | 74 |
| 2014 June | 58 | 16 | 74 |
| 2014 May | 37 | 19 | 56 |
| 2014 April | 75 | 25 | 100 |
| 2014 March | 38 | 18 | 56 |
Show all
