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Lupus
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Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome

J Mundo

Service of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

P Peris

Service of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain, 22848ppb{at}comb.es

A Monegal

Service of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

M Navasa

Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

R Cervera

Autoimmnume Diseases Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

N Guañabens

Service of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

We describe the case of a 31-year old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Key Words: aseptic necrosis • ischemic necrosis • avascular necrosis

Lupus, Vol. 15, No. 5, 304-307 (2006)
DOI: 10.1191/0961203306lu2301cr
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