NANOSNET

This was a really interesting case for me and I just wanted to share it with the group. Most likely all of you would be aware of this, but it was a new diagnosis for me to give a patient. Hopefully this isn't too mundane

1. 69  year old male, healthy, not a vasculopath, no diabetes or hypertension

2. 10 episodes at least over a 6-12 month period of just the left eye, either a curtain coming down or a curtain going up, lasting 5-10 minutes each time

3. the latest episode was a week ago and someone then referred the patient to me, I don't believe he saw anyone in the meantime

4. Zero symptoms of GCA

5. exam with me was totally normal including OCT of nerves, no hollenhorst plaques, temporal artery felt fine

I decided to send him to the hospital for an urgent workup. CBC,ESR, CRP normal, CTA head and neck normal, MRI brain normal, echocardiogram in march was normal(not a bubble study). they routinely check clotting factors and his PT was normal but his PTT was elevated. I asked them to repeat it and it was even more elevated. He has no clotting history. I ordered an antiphospholipid panel and it came back positive for anticardiolipin IgG and IgM and presence of lupus anticoagulant

So it looks like he has antiphospholipid syndrome.  He is now on ASA and plavix

he still has an echocardigoram with bubble study pending and I am repeating the labs in 12 weeks, as well as getting labs for Sjogren's, rheumatoid arthritis, and SLE, but I just wanted to share this with you all. APS wasn't in my thought process initially, but now it will be for amaurosis symptoms.

Bob