%PDF-1.4
%
27 0 obj
<>
endobj
24 0 obj
<>
endobj
76 0 obj
<>stream
Acrobat Distiller 4.05 for Macintosh
2004-12-02T18:45:26Z
2024-03-28T10:31:14-07:00
QuarkXPressª: AdobePS 8.6 (219)
2024-03-28T10:31:14-07:00
application/pdf
Heather
2001-464.jan
uuid:77170fd6-1dd2-11b2-0a00-f908275dc400
uuid:77170fd9-1dd2-11b2-0a00-810000000000
endstream
endobj
13 0 obj
<>
endobj
14 0 obj
<>
endobj
28 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
1 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>>
endobj
9 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>>
endobj
86 0 obj
[90 0 R]
endobj
87 0 obj
<>stream
1 g
/GS0 gs
0 792 m
0 792 l
f
q
-1 793 614 -794 re
W n
q
0 792.06 612 -792 re
W n
BT
/CS0 cs 0 0 0 1 scn
/GS1 gs
/TT0 1 Tf
0.00211 Tc 0.37289 Tw 9.7 0 0 10 54 713.1616 Tm
(patient succumbed in spite of early plasmapheresis and)Tj
-0.00011 Tc 0 Tw 0 -1.2 TD
(steroids.)Tj
0 Tc 0.1073 Tw 1.2371 -1.2 Td
[(Bone marrow necrosis, a relatively rare entity)64.9 (, is defined)]TJ
0.0786 Tw -1.2371 -1.2 Td
(morphologically as destruction of hemopoietic tissue includ-)Tj
-0.0352 Tw T*
(ing the stroma, with preservation of the bone)Tj
0 Tw 6.3 0 0 6.5 225.6125 668.4615 Tm
(8)Tj
-0.00011 Tc -0.0351 Tw 9.7 0 0 10 228.765 665.1616 Tm
(. Its known caus-)Tj
0 Tc 0.0007 Tw -18.017 -1.2 Td
(es are malignancy \(metastatic neoplasia, acute leukemia\), dis-)Tj
-0.03281 Tw T*
(seminated intravascular coagulation following radiotherapy or)Tj
0.2753 Tw T*
[(chemotherapy)64.9 (, sickle cell disease, and bacterial infections)]TJ
0.19411 Tw T*
[(\(especially septic shock\). )54.8 (Antiphospholipid antibodies have)]TJ
-0.00011 Tc 0.271 Tw T*
[(now emer)17.7 (ged as a new cause for bone marrow necrosis.)]TJ
0 Tc 0 Tw T*
(Bulvik, )Tj
/TT1 1 Tf
0.0451 Tw 3.2678 0 Td
(et al)Tj
/TT0 1 Tf
0 Tw 6.3 0 0 6.5 103.1049 596.4615 Tm
(8)Tj
0.0451 Tw 9.7 0 0 10 109.1198 593.1616 Tm
(in 1993 reported a young pregnant patient who)Tj
0.08279 Tw -5.6825 -1.2 Td
[(underwent emer)17.8 (gency cesarean section for preeclampsia and)]TJ
0.08009 Tw T*
(on the 3rd postoperative day developed extensive bone mar-)Tj
0.0975 Tw T*
(row necrosis resulting in severe pancytopenia. She had very)Tj
-0.00011 Tc 0.02969 Tw T*
[(high titers of IgG aCL. )17.8 (This was the first documented associ-)]TJ
0 Tc -0.01759 Tw T*
[(ation between bone marrow necrosis and aPL. Knickerbocker)39.8 (,)]TJ
/TT1 1 Tf
0.25999 Tw T*
(et al)Tj
/TT0 1 Tf
0 Tw 6.3 0 0 6.5 73.4924 524.4615 Tm
(9)Tj
0.25999 Tw 9.7 0 0 10 81.592 521.1616 Tm
(in 1982 described a young woman who developed)Tj
0.0141 Tw -2.8445 -1.2 Td
[(extensive bone marrow necrosis 2 days post partum. )17.8 (W)79.8 (e have)]TJ
-0.00011 Tc -0.01579 Tw T*
[(no information about her aCL)-197.4 (status as its assay was unknown)]TJ
0 Tc -0.0276 Tw T*
(at that time, but we know she had a history of recurrent throm-)Tj
0.02 Tc 0.4292 Tw T*
(bophlebitis in her legs and 3 spontaneous abortions.)Tj
-0.00011 Tc 0.069 Tw T*
[(Subsequently)64.8 (, 5 reports of association between bone marrow)]TJ
0 Tc 0.0369 Tw T*
[(necrosis and aPL)-250.1 (have been published. Paydas, )]TJ
/TT1 1 Tf
0.037 Tw 19.2988 0 Td
(et al)Tj
/TT0 1 Tf
0.00079 Tc 0 Tw 6.3 0 0 6.5 258.5277 452.4616 Tm
(10)Tj
-0.00011 Tc 9.7 0 0 10 267.6163 449.1616 Tm
(report-)Tj
0 Tc 0.0661 Tw -22.0223 -1.2 Td
[(ed a 27-year)19.8 (-old pregnant patient with a history of 9 miscar-)]TJ
0.19971 Tw T*
(riages/stillbirths, a cerebrovascular accident, and very high)Tj
-0.00011 Tc 0.14 Tw T*
[(titers of aPL)-353.3 (antibodies \(IgG and IgM\) who presented with)]TJ
0 Tc 0.02209 Tw T*
[(pancytopenia and bone marrow necrosis. In 1998, Murphy)64.9 (, )]TJ
/TT1 1 Tf
0 Tw 24.0206 0 Td
(et)Tj
-24.0206 -1.2 Td
(al)Tj
/TT0 1 Tf
-0.0564 Tc 6.3 0 0 6.5 61.545 392.4616 Tm
(11)Tj
0 Tc 0.1169 Tw 9.7 0 0 10 71.0516 389.1616 Tm
[(reported a 78-year)19.8 (-old man with lymphoma who devel-)]TJ
0.15511 Tw -1.7579 -1.2 Td
(oped bone marrow necrosis with pancytopenia; after death,)Tj
0.0009 Tw T*
[(his stored blood from the time of diagnosis revealed aPL)-214.1 (anti-)]TJ
-0.00011 Tc 0.04671 Tw T*
(bodies \(IgG\) > 100 U/l. Other case reports include Moore, )Tj
/TT1 1 Tf
0 Tc 0 Tw 24.0206 0 Td
(et)Tj
-24.0206 -1.2 Td
(al)Tj
/TT0 1 Tf
0.00079 Tc 6.3 0 0 6.5 61.545 344.4616 Tm
(12)Tj
0 Tc 0.2236 Tw 9.7 0 0 10 72.4445 341.1616 Tm
[(\(28-year)19.8 (-old woman with catastrophic )54.9 (APS presenting)]TJ
0.1098 Tw -1.9015 -1.2 Td
[(with multiple or)17.8 (gan thrombosis, hepatic infarcts, and a mis-)]TJ
-0.00011 Tc 0.1256 Tw T*
[(carriage\); Schaar)39.7 (, )]TJ
/TT1 1 Tf
0 Tc 7.5109 0 Td
(et al)Tj
/TT0 1 Tf
0.00079 Tc 0 Tw 6.3 0 0 6.5 145.0444 320.4616 Tm
(13)Tj
0 Tc 0.1255 Tw 9.7 0 0 10 154.9925 317.1616 Tm
(\(a young woman with catastrophic)Tj
-0.00011 Tc 0.02521 Tw -10.4116 -1.2 Td
(APS with renal failure, cerebral infarcts, bone marrow necro-)Tj
0.0199 Tc 0.5766 Tw T*
(sis, skin ulcers, and nasal septal perforation\); and)Tj
-0.00011 Tc 0 Tw T*
(Spyropoulos)Tj
0.00079 Tc 6.3 0 0 6.5 103.0376 284.4616 Tm
(14)Tj
0 Tc 0.2206 Tw 9.7 0 0 10 113.9084 281.1616 Tm
(\(a man with inferior vena cava obstruction,)Tj
-0.00011 Tc 0.02499 Tw -6.1761 -1.2 Td
(extensive marrow necrosis, and aPL\).)Tj
0 Tc 0.16299 Tw 1.2371 -1.2 Td
[(Interestingly)64.9 (, 4 of the 7 above mentioned cases of bone)]TJ
0.23061 Tw -1.2371 -1.2 Td
(marrow necrosis have been described in pregnant patients)Tj
-0.00011 Tc 0.21111 Tw T*
(\(during pregnancy or after delivery/miscarriage\), as in our)Tj
0 Tc 0.07629 Tw 27.2165 48 Td
[(patient. Our patient, however)39.8 (, is the first to be reported with)]TJ
-0.00011 Tc 0.328 Tw T*
[(both HELLP)-541.2 (and catastrophic )54.8 (APS at the same time. It)]TJ
0 Tc 0.1236 Tw T*
(remains to be determined what change of internal milieu in)Tj
0.0475 Tw T*
(pregnancy predisposes an individual to this devastating com-)Tj
0 Tw T*
(plication.)Tj
/TT2 1 Tf
-0.00011 Tc 0 -2.4 TD
(REFERENCES)Tj
/TT0 1 Tf
0 Tc 0.0249 Tw 8 0 0 8 325 631.1616 Tm
[(1.)-875 (Asherson RA. )17.7 (The catastrophic antiphospholipid syndrome. )]TJ
1.675 -1.25 Td
(J Rheumatol 1992;19:508-12.)Tj
-1.675 -1.25 Td
[(2.)-875 (Asherson RA, Cervera R, Piette JC, et al. Catastrophic)]TJ
1.675 -1.25 Td
(antiphospholipid syndrome: clinical and laboratory features of 50)Tj
0 -1.25 TD
(patients. Medicine 1998;77:195-207.)Tj
-0.00011 Tc -1.675 -1.25 Td
[(3.)-875.1 (Rogas-Rodriguez J, Garcia-Carasco M, Ramos-Casals M, et al.)]TJ
0 Tc 1.675 -1.25 Td
(Catastrophic antiphospholipid syndrome: Clinical description and)Tj
T*
(triggering factors in 8 patients. J Rheumatol 2000;27:238-40.)Tj
-0.00011 Tc -1.675 -1.25 Td
[(4.)-875.1 (Ornstein MH, Rand JH. )54.8 (An association between refractory HELPP)]TJ
0 Tc 1.675 -1.25 Td
(syndrome and antiphospholipid antibodies during pregnancy; a)Tj
T*
(report of two cases. J Rheumatol 1994;21:1360-4.)Tj
-0.00011 Tc -1.675 -1.25 Td
[(5.)-875.1 (Neuwelt CM, Daikh DI, Linfoot JA, et al. Catastrophic)]TJ
0 Tc 1.675 -1.25 Td
(antiphospholipid syndrome: Response to repeated plasmapheresis)Tj
T*
[(over three years. )54.8 (Arthritis Rheum 1997;40:1534-9.)]TJ
-0.00011 Tc -1.675 -1.25 Td
[(6.)-875.1 (Kniaz D, Eisenber)17.7 (g GM, Elrad H, Johnson CA, )17.7 (V)111 (alaitis J, Ber)17.7 (gman)]TJ
0 Tc 1.675 -1.25 Td
(H. Postpartum hemolytic uremic syndrome associated with)Tj
T*
(antiphospholipid antibodies: a case report and review of literature.)Tj
T*
(Am J Nephrol 1992;12:126-33.)Tj
-0.00011 Tc -1.675 -1.25 Td
[(7.)-875.1 (Durand JM, Lefevre P)110.7 (, Kaplanski G, Souberand J. )17.7 (Thrombotic)]TJ
0 Tc 1.675 -1.25 Td
(microangiopathy and the antiphospholipid antibody syndrome. )Tj
T*
(J Rheumatol 1991;18:1916-7.)Tj
-1.675 -1.25 Td
[(8.)-875 (Bulvik S, )54.8 (Aronson I, Ress S, Jacobs P)110.8 (. Extensive bone marrow)]TJ
1.675 -1.25 Td
[(necrosis associated with antiphospholipid antibodies. )54.8 (Am J Med)]TJ
0 Tw T*
(1995;98:572-4.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(9.)-875.1 (Knickerbocker )17.7 (WJ, Quenville NF)79.7 (. )17.7 (W)39.7 (idespread marrow necrosis)]TJ
0 Tc 1.675 -1.25 Td
[(during pregnancy)64.9 (. Skeletal Radiol 1982;9:37-40.)]TJ
-0.00011 Tc -2.175 -1.25 Td
[(10.)-875.1 (Paydas S, Kocak R, Zorludemir S, Baslamisli F)79.7 (. Bone marrow)]TJ
0 Tc 2.175 -1.25 Td
(necrosis in antiphospholipid syndrome. J Clin Pathol 1997;)Tj
0 Tw T*
(50:261-2.)Tj
0.0249 Tw -2.1381 -1.25 Td
[(1)36.9 (1.)-875 (Murphy PT)74 (, Shivkumaran N, Casey MC, Liddicoat )54.8 (A, )17.7 (W)79.8 (ood JK.)]TJ
-0.00011 Tc 2.1381 -1.25 Td
[(L)54.8 (ymphoma associated bone marrow necrosis with raised)]TJ
0 Tc T*
[(anticardiolipin antibody)64.9 (. J Clin Pathol 1998;51:407-9.)]TJ
-0.00011 Tc -2.175 -1.25 Td
[(12.)-875.1 (Moore J, Ma DD, Concannon )54.8 (A. Non-malignant bone marrow)]TJ
0 Tc 2.175 -1.25 Td
(necrosis: a report of two cases. Pathology 1998;30:318-20.)Tj
-0.00011 Tc -2.175 -1.25 Td
[(13.)-875.1 (Schaar CG, Ronday KH, Boets EPM, van der Lubbe P)91.7 (AHM,)]TJ
0 Tc 2.175 -1.25 Td
(Breedveld FC. Catastrophic manifestation of the antiphospholipid)Tj
T*
(syndrome. J Rheumatol 1999;26:2261-4.)Tj
-2.175 -1.25 Td
[(14.)-875 (Spyropoulos )54.8 (AC. Membranous obstruction of the inferior venacava)]TJ
2.175 -1.25 Td
(and extensive bone marrow necrosis associated with catastrophic)Tj
T*
(antiphospholipid syndrome. J Clin Rheumatol 1999;5:279-84.)Tj
ET
/CS0 CS 0 0 0 1 SCN
54 54 m
558 54 l
S
BT
/TT1 1 Tf
8 0 0 8 54.5 35.9844 Tm
[(Sinha, et al: Bone marr)37.1 (ow necr)36.9 (osis and )17.7 (APS)]TJ
0 Tw 61.4375 -0.0313 Td
(197)Tj
ET
0 0 0 0 scn
/GS0 gs
101.25 59.08 407.5 -10.83 re
f*
0.5 w
101.25 59.08 407.5 -10.83 re
S
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS2 gs
/T1_0 8 Tf
120.092 51 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2002. All rights reserved.)Tj
ET
Q
BT
0 g
/GS2 gs
/T1_1 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS2 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS2 gs
-16.72996 0 Td
(Downloaded on March 28, 2024 from )Tj
ET
endstream
endobj
69 0 obj
<>
endobj
81 0 obj
<>
endobj
37 0 obj
<>
endobj
30 0 obj
<>
endobj
38 0 obj
<>
endobj
36 0 obj
<>
endobj
64 0 obj
<>stream
HdVpT͋Ѡ,!$^AHAg]v4=7ROyܱD_lGpY. ֎s^Ja97/kL l mQ5iy9 eIl[m㾯|k%QL,%(C#S
)>1BiS%.md!4Ĥ+B##עkTZviЋ )
ta-R6kwOm<-=X'%n/JRl!J==M7TD\E
X&Z|t0aڂALN#b)R'2IjEv(CV[T3r'cVeXIErFUˊbJ\HO#' Aa^u\&|"GRJ
&V^V 0*Mf7]X{Yx][|8~W$BeWeYFfOZF I
BxMސ^Ei!,5WWqq,1̰y*&[
#N}N;]nvǐ1W1?aF9Gǽ} +Xs%|!_2ϼ
l/j('[EѸ`,03:MVO>bvRkhuZZvXѬY>ʮԲ7U8)= VJ`rխR^wzU(P樂=zƪ16r&b2oG[7eŗ7Y{:"x0#KE,w_<&8ھ(/-U6Nfh=~sK-~xJtzνYKߝ9ͫiXazѳݛm}'j큕|>k}`ZsF]cc88>3ؽ;ַw6k7&^6t1)r1&
8Ę`l+DX"^;d"ATS6UI)mPj'meovJוw7۽n[# .tD85r A#fid F l
5,.U# Fv 4hd --9y1}_%|$iM+Fؾ^"=M nHsd-Wtk(v3
eP_Fa)iV1/W8H!ڐu;[N Wڄۄm66M_uۤۈ(~X"|TZɞ0ތ/Ņ:.BCvn;tۢ底t]{\\1Wx W8,`4*|0*
h:8Iu"$gj2w5TMH^
0p+a[
x{T,tn~JQ\UUm-U\P,WysUF*э Uo!%~HD:`(thE?9nY6hڶ>ݿ'qd
Uz8ϲ~ͰfuT
aUi. *5VxRV"E
Q [F'`Kg_F
^bRPXWC
uS<
`s?3aL4C*Ti1 K 272U,o`E?OPY"D90Aej*&':)ӏ%;0βwALߕ\^
Oqx~8AK ȚNTH̢F#ݛM}+wF6S^xIqF閨EtS*m
c%0u}>syTKW)mU&"}jm56ccbZ=خqc+YL`3J6]UZ&RE_Xѹ\J;]5}Wr2tûyOgv筼'<=-9tcff̈́Y ~UWI!(쇲(Bev(=ӷFX1C:GEI:fnv3dLmikW#
OrCE1
36oJg}oɊ5C?Έ-`9h0FIaU)b[IqrvoFR2` )
00en&%~ԧK,dI 0 2ILڙ^
][ɲJqV)N}0/f0y;;ݭՈcF?jz1{;54uOcVp3_q]ڦ[ʡ`epO1worZfTʽpdX5'3I6X
U{>]beXrj}zjvr4l3sp&YZ qBNX) 9jBvL$f(F)ݜj7vdLT
WNLl))-|;C9Y-/QÿWCcqM]w3#4aueew|luFX+,JKw~.i^+i?-&>Cu4\3qIr!\Tပ&{|^_r 㮱}ьb|_ZZ'EnaTH{0n=?7F~P/Ss:;Bs=\y&huKXߖ7w
;3^^A>jk˾z_pQrwQJj=A+;|{w)BI緤Y4D43C>gϊLX,_#Ͳ-gI,|{RqejN]7a||cIFSX/χl!sW0 f, K,)ՙV/=r/<ɉCxExGQq|}{v^ɑ%]F1b 9% (2cc6mtZ
0b#&PKeSiAie0ͭ}._{cħA A<֑4iaW_/zǸsϸooxf=6su)e[R{sQۨKѝ %9A9lr68) J-BAEWTjoH%-
:TK)xSTd(-ڻHN%ly fp76{J vmiLNjWY- siJ?O/AEp\-v1*+) ]l6>(|ȯD)0w0rOîj
;Kc}ܴN$tt|JfV-Ɇq}H.eaT.^};Z a1Q)(Rk(9_"Gnl f;Og/'Њ]\w ''ia֨ci 8@+PA
ү7Ap:#wHK̑(RR13*!lG+JEp>j?+f
|iܬu@QB