Skip to main content

Advertisement

SpringerLink
Log in

Transient antiphospholipid antibodies associated with acute infections in children: a report of three cases and a review of the literature

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

We describe two previously healthy children who had multiple ecchymoses several days after acute infection. In both cases, the prothrombin time (PT) and the activated partial thromboplastin time (APTT) were prolonged. Further examinations revealed the presence of lupus anticoagulant (LA), phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT), and low serum complement. In both cases, we confirmed the presence of a serum immune complex. The patients’ symptoms improved spontaneously within 1 week, and all laboratory data normalized within several months. We also describe another asymptomatic case positive for LA and aPS/PT presumably associated with cytomegalovirus infection. The prevalence of transient antiphospholipid antibodies associated with viral infections in children must be much higher than we expected. We have to take it into consideration when we see abnormal coagulation results, but the occurrence of significant bleeding symptoms is rare.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

aPL:

Antiphospholipid antibodies

SLE:

Systemic lupus erythematosus

LA:

Lupus anticoagulant

LAHS:

LA-hypoprothrombinemia syndrome

APS:

Antiphospholipid syndrome

β2-GPI:

β2-glycoprotein I

aPS/PT:

Phosphatidylserine-dependent antiprothrombin antibodies

dRVVT:

Dilute Russell viper venom time

PT:

Prothrombin time

APTT:

Activated partial thromboplastin time

ELISA:

Enzyme-linked immunosorbent assay

aCL:

Anticardiolipin antibodies

aCL/β2-GPI:

β2-GPI-dependent aCL

References

  1. Arvieux J, Darnige L, Caron C, Reber G, Bensa JC, Colomb MG (1995) Development of an ELISA for autoantibodies to prothrombin showing their prevalence in patients with lupus anticoagulant. Thromb Haemost 74:1120–1125

    PubMed  CAS  Google Scholar 

  2. Atsumi T, Ieko M, Bertolaccini ML, Ichikawa K, Tsutsumi A, Matsuura E, Koike T (2000) Association of autoantibodies against the phosphatidylserine-prothrombin complex with manifestations of the antiphospholipid syndrome and with the presence of lupus anticoagulant. Arthritis Rheum 43:1982–1993

    Article  PubMed  CAS  Google Scholar 

  3. Bajaj SP, Rapaport SI, Barclay S, Herbst KD (1985) Acquired hypoprothrombinemia due to non-neutralizing antibodies to prothrombin: mechanism and management. Blood 65:1538–1543

    PubMed  CAS  Google Scholar 

  4. Bajaj SP, Rapaport SI, Fierer DS, Herbst KD, Schwartz DB (1983) A mechanism for the hypoprothrombinemia of the acquired hypoprothombinemia-lupus anticoagulant syndrome. Blood 61:684–692

    PubMed  CAS  Google Scholar 

  5. Becton DL, Stine KC (1997) Transient lupus anticoagulants associated with hemorrhage rather than thrombosis: the hemorrhagic lupus anticoagulant syndrome. J Pediatr 130:998–1000

    Article  PubMed  CAS  Google Scholar 

  6. Bevers EM, Galli M, Barbui T, Comfurius P, Zwaal RFA (1991) Lupus anticoagulant IgG’s (LA) are not directed to phospholipids only, but to a complex of lipid-bound human prothrombin. Thromb Haemost 66:629–632

    PubMed  CAS  Google Scholar 

  7. Brandt JT, Triplett DA, Alving B, Scharrer I (1995) Criteria for the diagnosis of lupus anticoagulant: an update. Thromb Haemost 74:1185–1190

    PubMed  CAS  Google Scholar 

  8. Eberhard A, Sparling C, Sudbury S, Peter F, Ronald L, Earl S (1994) Hypoprothrombinemia in childhood systemic lupus erythematosus. Semin Arthritis Rheum 24:12–18

    Article  PubMed  CAS  Google Scholar 

  9. Galli M, Beretta G, Daldossi M, Bevers EM, Barbui T (1997) Different anticoagulant and immunological properties of anti-prothrombin antibodies in patients with antiphospholipid antibodies. Thromb Haemost 77:486–491

    PubMed  CAS  Google Scholar 

  10. Grau E, Real E, Pastor E, Ivorra J, Quecedo E (1997) Prothrombin deficiency and hemorrhage associated with a lupus anticoagulant. Am J Hematol 54:85

    Article  PubMed  CAS  Google Scholar 

  11. Harris EN, Gharavi AE, Patel SP, Hughes GR (1987) Evaluation of the anti-cardiolipin antibody test: report of an international workshop held 4 April 1986. Clin Exp Immunol 68:215–222

    PubMed  CAS  Google Scholar 

  12. Helene CFC, David GH, John WU, Louis DW, Ross TAM (1997) A new method for characterization and epitope determination of a lupus anticoagulant-associated neutralizing antiprothrombin antibody. Am J Clin Pathol 107:196–204

    Google Scholar 

  13. Houbouyan L, Armengaud D, Leroy B, Roussi J, Gallet JP, Goguel A (1984) Antiprothrombinase anticoagulant and acquired prothrombin deficiency in childhood viral pathology. Spontaneous recovery. Arch Fr Pediatr 41:417–420

    PubMed  CAS  Google Scholar 

  14. Hudson N, Duffy CM, Rauch J, Paquin JD, Esdaile JM (1997) Catastrophic haemorrhage in a case of pediatric primary antiphospholipid syndrome and factor II deficiency. Lupus 6:68–71

    Article  PubMed  CAS  Google Scholar 

  15. Humphries JE, Acker MN, Pinkston JE, Ruddy S (1994) Transient lupus anticoagulant associated with prothrombin deficiency: unusual case of bleeding in a 5-year-old girl. Am J Pediatr Hematol Oncol 16:372–376

    PubMed  CAS  Google Scholar 

  16. Jaeger U, Kapiotis S, Pabinger I, Puchhammer E, Kyrle PA, Lechner K (1993) Transient lupus anticoagulant associated with hypoprothrombinemia and factor XII deficiency following adenovirus infection. Ann Hematol 67:95–99

    Article  PubMed  CAS  Google Scholar 

  17. Bernini JC, Buchanan GR, Ashcraft J (1993) Hypoprothrombinemia and severe hemorrhage associated with a lupus anticoagulant. J Pediatr 123:937–939

    Article  PubMed  CAS  Google Scholar 

  18. Khamashta MA, Hughes GR (1995) Antiphospholipid antibodies and antiphospholipid syndrome. Curr Opin Rheumatol 7:389–394

    Article  PubMed  CAS  Google Scholar 

  19. Lillquist KB, Dyerberg J, Krogh-Jensen M (1978) The absence of factor II in a child with systemic lupus erythematosus. Acta Paediatr Scand 67:533–536

    Article  PubMed  CAS  Google Scholar 

  20. Male C, Lechner K, Eichinger S, Kyrle PA, Kapiotis S, Wank H, Kaider A, Pabinger I (1999) Clinical significance of lupus anticoagulants in children. J Pediatr 134:199–205

    Article  PubMed  CAS  Google Scholar 

  21. Lee MT, Nardi MA, Hadzi-Nesic J, Karpatkin M (1996) Transient hemorrhagic diathesis associated with an inhibitor of prothrombin with lupus anticoagulant in a 1 1/2-year-old girl: report of a case and review of the literature. Am J Hematol 51:307–314

    Article  PubMed  CAS  Google Scholar 

  22. Bernstein ML, Salusinsky-Sternbach M, Bellefleur M, Esseltine DW (1984) Thrombotic and hemorrhagic complications in children with the lupus anticoagulant. Am J Dis Child 138:1132–1135

    PubMed  CAS  Google Scholar 

  23. Schmugge M, Tolle S, Marbet GA, Laroche P, Meili EO (2001) Gingival bleeding, epistaxis and hematoma three days after gastroenteritis: the haemorrhagic lupus anticoagulant syndrome. Eur J Pediatr 160:43–46

    Article  PubMed  CAS  Google Scholar 

  24. Matsuda J, Saitoh N, Gotoh M, Kawasugi K, Gohchi K, Tsukamoto M (1996) Phosphatidyl serine-dependent antiprothrombin antibody is exclusive to patients with lupus anticoagulant. Br J Rheumatol 35:589–591

    Article  PubMed  CAS  Google Scholar 

  25. Matsuura E, Igarashi Y, Fujimoto M, Ichilawa K, Suzuki T, Sumida T, Yasuda T, Koike T (1992) Heterogeneity of anticardiolipin antibodies defined by the anticardiolipin cofactor. J Immunol 148:3885–3891

    PubMed  CAS  Google Scholar 

  26. Galli M, Barbui T (1999) Antiprothrombin antibodies: detection and clinical significance in the antiphospholipid syndrome. Blood 93:2149–2157

    PubMed  CAS  Google Scholar 

  27. Shwartz S, Esseltine DW (1984) Postextraction haemorrhage in a young male patient with systemic lupus erythematosus. Oral Surg Oral Med Oral Pathol 57:254–257

    Article  PubMed  Google Scholar 

  28. Baca V, Montiel G, Meillon L, Pizzuto J, Catalan T, Juan-Shum L, Nieva B (2002) Diagnosis of lupus anticoagulant in the lupus anticoagulant-hypoprothrombinemia syndrome: report of two cases and review of the literature. Am J Hematol 71:200–207

    Article  PubMed  Google Scholar 

  29. Yacobvish JR, Uziel Y, Friedman Z, Radnay J, Wolach B (2001) Diffuse muscular haemorrhage as presenting sign of juvenile systemic lupus erythematosus and lupus anticoagulant hypoprothrombinaemia syndrome. Rheumatology 40:585–587

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan

    H. Mizumoto, M. Shiota, A. Hata & D. Hata

  2. Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital, Amagasaki, Japan

    T. Maihara

  3. Department of Pediatrics, Kishiwada City Hospital, Kishiwada, Japan

    E. Hiejima & S. Seto

  4. Department of Medicine II, Hokkaido University School of Medicine, Sapporo, Japan

    T. Atsumi & T. Koike

Authors
  1. H. Mizumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Maihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Hiejima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Shiota
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Seto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Atsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Hata.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mizumoto, H., Maihara, T., Hiejima, E. et al. Transient antiphospholipid antibodies associated with acute infections in children: a report of three cases and a review of the literature. Eur J Pediatr 165, 484–488 (2006). https://doi.org/10.1007/s00431-006-0117-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-006-0117-0

Keywords

Search

Navigation