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Ovarian Vein Thrombosis May Occur in Antiphospholipid Syndrome, May Be Underdiagnosed

Ovarian vein thrombosis may occur in women with antiphospholipid syndrome, with or without pregnancy, and may be underdiagnosed given the absence of clinical symptoms, reports a study from France.

Although ovarian vein thrombosis (OVT) is mainly seen during postpartum, and has never been reported in patients with antiphospholipid syndrome (APS), this article describes 2 atypical cases of asymptomatic OVT in women with primary APS.

Marc Andre, MD, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, and colleagues, describe the case of a 33-year-old woman who presented with left chest pain and dyspnoea at 33 weeks' gestation during her fourth pregnancy. Fever and abdominal pain were absent, but she had a high pulse rate (90 beats/minute) and raised jugular vein pressure.

Laboratory tests were positive for lupus anticoagulant. All tests were normal or negative for antithrombin III, protein C and S deficiencies, factor V Leiden, and prothrombin G20210A mutation. The patient did not have a history of thrombosis.

After giving birth through caesarean section, the patient underwent thrombectomy of the right atrium and started on intravenous heparin followed by oral anticoagulation. She was diagnosed with primary APS after computed tomography (CT) scans revealed a pulmonary embolism and a OVT. Two years after treatment with long-term fluindione, the woman remained free of symptoms suggestive of systemic lupus.

In the second case, a 73-year-old woman presented with weight loss, depression, and asthenia and a history of postpartum deep venous thromboses of the lower limbs. She was on low-dose aspirin and prednisone daily for purpuric lesions of the hands. Laboratory results showed normal levels of immunoglobulins and cryoglobulin was negative, and tests were normal or negative for antithrombin III, protein C and S deficiencies, factor V Leiden, and prothrombin G20210A mutation. An abdominopelvic CT scan revealed a silent OVT. After stopping steroid treatment and receiving intravenous heparin followed by fluindione for 4 months, the OVT disappeared. At 4 years follow-up, the woman was still on fluindione treatment and was well.

Based on these cases that show that OVT can occur in patients with APS, with or without pregnancy, the authors conclude that "given that pelvic pain or tenderness is far from constant, this complication may be underdiagnosed."

Arthritis Rheum 2004 Jan;50:1:183-6. "Ovarian vein thrombosis in the antiphospholipid syndrome"

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