Bilateral Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome during Chronic Graft-versus-host Disease

• Published in: Internal Medicine Vol. 57; no. 10; pp. 1439 - 1444
• Main Authors: Minami, Mariko, Muta, Tsuyoshi, Adachi, Masahiro, Higuchi, Masakazu, Aoki, Kenichi, Ogawa, Ryosuke
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.05.2018; Japan Science and Technology Agency
• Subjects: Adrenal Gland Diseases - diagnostic imaging; Adrenal Gland Diseases - drug therapy; Adrenal glands; adrenal hemorrhage; Adrenal Insufficiency - diagnosis; Anticoagulants - therapeutic use; antiphospholipid antibody syndrome; Antiphospholipid syndrome; Antiphospholipid Syndrome - diagnosis; Antiphospholipid Syndrome - drug therapy; Case Report; Diagnosis; Fatigue; Fatigue - diagnosis; Graft vs Host Disease - diagnosis; graft-versus-host disease; Graft-versus-host reaction; Hematopoietic stem cells; Hemorrhage; Hemorrhage - diagnostic imaging; Hemorrhage - drug therapy; Humans; Hyponatremia; Hyponatremia - diagnosis; Hypotension; Hypotension - diagnosis; Internal medicine; Magnetic Resonance Imaging; Male; Middle Aged; Respiratory Tract Infections - diagnosis; Stem cell transplantation; Transplantation; adrenal hemorrhage; graft-versus-host disease; antiphospholipid antibody syndrome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.9820-17

We present the case of a 56-year-old man with an upper respiratory infection followed by fatigue, hypotension, and hyponatremia. Bilateral adrenal hemorrhage was confirmed, based on T2-weighted magnetic resonance imaging. The patient had previously undergone allogeneic hematopoietic stem cell transplantation and had been diagnosed with antiphospholipid syndrome (APS) during the development of chronic graft-versus-host disease. A prompt diagnosis and steroid replacement, in addition to anticoagulant therapy, resulted in a favorable outcome. Once the diagnosis of APS has been confirmed, which might be the sign of bilateral adrenal hemorrhage, the initial manifestations of adrenal insufficiency should never be overlooked.