Antiphospholipid syndrome (APS) is known to cause critical limb ischemia leading to limb loss or death from arterial occlusion. We reported a 45-year-old woman with critical digital ischemia and was suspected secondary to APS. This woman presented to the Emergency Department (ED) for the third time because of recurrent pain and numbness in the fingertips of her left hand with bluish discoloration of the left little finger. Her ulnar artery became faint on palpation, and her left fifth finger was cool, cyanotic, with prolonged capillary refill time (CRT) and unrecognised signal in SpO2. Angiography and ultrasound showed proximal thrombosis of the ulnar artery. Thrombectomy was performed twice because graft thrombosis had occurred during the first operation. The rheumatology team treated her as APS and administered antiplatelet drugs. We hope this case report will raise awareness among emergency physicians for early recognition and provide optimal treatment.
Critical Digital Ischemia Secondary to Ulnar Artery Thrombosis in Suspected Antiphospholipid Syndrome
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Abstrak
Sindrom antifosfolipid (APS) ialah salah satu punca arteri tersumbat yang boleh menyebabkan iskemia anggota badan yang teruk dan mengakibatkan kehilangan anggota badan dan juga kematian. Kami melaporkan seorang wanita berumur 45 tahun yang mempunyai iskemia digital yang teruk yang disyaki akibat APS. Wanita tersebut dihantar ke Jabatan Kecemasan (ED) buat kali ketiga dengan kesakitan berulang dan kebas di hujung jari kiri dan jari kelengkeng biru. Dia mempunyai arteri ulna yang lemah semasa palpasi, jari kelengkeng kiri yang sejuk, sianosis, masa isi semula kapilari yang berpanjangan (CRT) dan isyarat SpO2 yang tidak boleh dibaca. Angiografi dan ultrasound menunjukkan trombus arteri ulnar proksimal. Trombektomi dijalankan dua kali kerana trombosis arteri graf berlaku dalam pembedahan pertama. Pasukan reumatologi merawatnya sebagai sindrom antifosfolipid dengan antiplatelet. Kami berharap laporan kes ini akan meningkatkan kesedaran doktor kecemasan tentang pengesanan awal dan dapat menjalankan rawatan yang berkesan.
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