Bone Marrow Necrosis in A Male Patient with Anti-Phospholipid Syndrome: A Case Report with Literature Review

Abstract

Anti-phospholipid syndrome (APS) is a systemic autoimmune disease causing arterial and venous thrombosis, leading to macrovascular and microvascular complications. Bone marrow necrosis (BMN) is defined as the death of hematopoietic tissue and the loss of fat cells in a bone marrow biopsy. BMN is typically associated with a poor prognosis, with most patients dying within weeks. We present a case of BMN in a 32-year-old male patient with APS admitted to our hospital. The patient presented with bilateral non-healing leg ulcers and bilateral lower limb edema. The findings of the duplex ultrasound were consistent with old bilateral deep vein thromboses in the calves. The presence of acute kidney injury and proteinuria prompted a renal biopsy, which revealed chronic thrombotic microangiopathy. Bone marrow biopsy revealed BMN. Unfortunately, the patient did not respond to immunosuppressive treatment and passed away due to septic shock. The unique features in the patient’s presentation, combined with the availability of extensive data on the patient’s history and investigations, further enhance its significance. It is not possible to establish a cause-and-effect relationship or draw conclusive findings from this case report alone. More case reports from clinicians who come across BMN in patients with APS are needed to broaden our understanding of the pathogenesis, presentation, management, and outcomes.