Journal of Clinical Case Reports

Adenomyosis is a common, benign uterine disease. Acute cerebral infarction (CI) associated with adenomyosis is rarely reported and difficult to treat. We experienced successful treatment for this disease. A 50-year-old woman presented with a two-day history of visual disturbance. Magnetic resonance imaging showed multiple tiny diffusion-weighted high-density spots on several lobes. No common risk factors for stroke were detected. Cancer antigen 125 Level was 999 U/mL, along with massively expanded uterus and adnexa. Based on the diagnosis of benign adenomyosis, direct oral anticoagulants and GnRH agonists were administered for CI and adenomyosis, respectively. Acute CI recurred seven days after admission. We suspected a relationship between infarction and adenomyosis, and concluded hysterectomy as a proper treatment strategy based on literature. Eighteen months after hysterectomy, no recurrence of CI without anti-thrombus medications has been detected. Hysterectomy is a radical therapy that is effective in preventing acute CI due to adenomyosis.

Coarctation of aorta (CoA) is a common cause of congenital heart disease (CHD) which is caused by narrowing of aorta. Monochorionic (MC) twins are at increased risk of CHDs, especially acquired CHDs in twin-twin transfusion syndrome (TTTS). CoA is a rare coincidence with TTTS. MC twin pregnancies have been increasing in last decades due to an increase in maternal age and extensive use of assisted reproductive technologies. Multiple cardiac abnormalities in MC twins with TTTS are to be expected due to cardiac hemodynamic changes. Therefore, more attention to this group of patients should be given regarding heart abnormalities. Prenatal diagnosis of CoA is difficult but it is necessary given the importance of treatment after birth. Here we present a case of CoA coexisting in the donor infant of a twin with TTTS.

Background: Antiphospholipid syndrome is an autoimmune, hypercoagulable state that is caused by antiphospholipid antibodies. Anticardiolipin antibodies, anti-b2 glycoprotein-I, and lupus anticoagulants are the main autoantibodies found in antiphospholipid syndrome. In this brief communication, we describe the case of a woman who has been suffering from treatment-resistant and difficult to manage bipolar disorder (BPD) with fluctuating thrombocytopenia and neurological findings with positive lupus anticoagulant. This was important because it was a multicomplicated problem and showed antiphospholipid syndrome with lupus. We propose it to be a consequence of an atypical presentation of APS.

Case presentation: The known case of APS (antiphospholipid syndrome) and SLE (systemic lupus erythematous) with a history of kidney transplantation for 14 years, infertility, and CVA (cerebrovascular accident). According to the history of infertility, she had an abortion. Lab data reveals a positive anticoagulant antibody. The microscopy pathology data showed mainly necrotic chorionic villi admixed with extensive hemorrhage and evidence of thrombosis.

Conclusion: This is the report of APS with SLE (systemic lupus erythematosus) and miscarriage. Patients with menopausal history and a history of infertility should also be considered for fertility.