Lung Adenocarcinoma Characterized By Multiple Thromboemboli Was Misdiagnosed As Primary Antiphospholipid Antibody Syndrome:a Cause Report

Background:The relationship between venous thromboembolism (VTE) and malignancy has been recognized since1865. Some clinical thromboembolic events have been found to occur before the diagnosis of malignancy. Since the1980s, more and more physicians pay attention to another important thrombogenic mechanism mediated by antiphospholipid antibodies. Antiphospholipid antibodies are significantly prevalent in patients with infectious diseases, autoimmune diseases, malignant diseases, or hepatic diseases and even in healthy elderly individuals. APS is a systemic autoimmune disorder which characterised by arterial and venous thrombosis, adverse outcomes in pregnancy, and raised titers of aPLs. Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterised by arterial and venous thrombosis, adverse outcomes in pregnancy, and raised titers of aPLs. Thrombotic events associated with aPL antibodies can be a predictor of malignancy.Objective:In this report, we described a case of lung adenocarcinoma in which the presenting symptoms were multiple organ thrombotic phenomena, misdiagnosed as Primary antiphospholipid syndrome. Heighten physicians’ awareness of the relationship between malignancy, thromboembolic events and antiphospholipid antibodies. Thrombotic events associated with positive antiphospholipid antibodies can be the first manifestation of malignancy. Any patient with a suspected antiphospholipid syndrome should be seen by a multidisciplinary team of specialist for diagnosis. Early recognized of the hidden cancers and early treatment can reduce mortality and morbidity in patients with positive antiphospholipid antibodies.Methods:We study looked back a case of lung adenocarcinoma in which the presenting symptoms were multiple organ thrombotic phenomena, misdiagnosed as Primary antiphospholipid syndrome. A41-year-old female was admitted to the department of respiratory medicine with complaints of "aggravating chest tightness accompanying hemoptysis." According to the ECG and CTPA, we diagnosed pulmonary embolism and give low molecular weight heparin (LMWH) for anticoagulation. Two hours after admission, she suffed from the acute anterior myocardial infarction. Five days after admission, she suffered cerebral infarction. Laboratory evaluation on admission was notable for an elevated CRP (25.4mg/1), elevated D-Dimer (1226.4ug/ml), elevated anti-β2-glycoproteinJ(β2GPI)-IgM (43.91RU/ml) and elevated anticardiolipin antibody(IgG aCL48.76U/ml,IgM aCL43.83U/ml). We performed the fiberoptic bronchoscopy for her and the biopsy showed lung adenocarcinoma.Conclusion:This case report underlines the need for early diagnosis and reasonable treatment of oncology patients with positive aPLs. The occurrence of this case should heighten physicians’ awareness of the relationship between cancer, thrombotic envents and aPLs. Diagnosis and differential diagnosis of suspect APS need the collaboration of multidisciplinary team of specialist. It is anticipated that early recognized of the hidden cancers and early treatment can reduce mortality and morbidity in patients with positive aPLs.