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Bilateral adrenal haemorrhage in antiphospholipid syndrome and a short review of the literature
  1. Adriani Samuel Cherico1,
  2. Richard J White2,
  3. Deep Shah2 and
  4. Rama Bhagavatula2
  1. 1Department of Internal Medicine, Allegheny General Hospital - Western Pennsylvania Hospital Medical Education Consortium, Pittsburgh, Pennsylvania, USA
  2. 2Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Adriani Samuel Cherico; adriani.cherico{at}


Antiphospholipid syndrome (APS) is an uncommon autoantibody-mediated condition characterised by acquired thrombophilia resulting in recurrent arterial and venous thrombosis. An inciting factor allows for the exposure of endothelial phospholipids, causing antigen formation and subsequent creation of antibodies. A woman in her 70s presented after vehicular trauma, suffering broken ribs, pneumothorax and incidentally discovered left adrenal haemorrhage. Two weeks later she presented with acute-onset abdominal pain and was found to have a right adrenal gland haemorrhage on CT imaging without interval trauma occurring. The patient had antiphospholipid antibody laboratory studies drawn and was given intravenous heparin with a bridge to warfarin at discharge. Laboratory results returned positive for lupus anticoagulant, beta-2 glycoprotein and anticardiolipin antibodies indicating triple positivity, with repeated laboratory tests positive in 12 weeks’ time, confirming the diagnosis. Bilateral adrenal haemorrhage, rather than traditional venous thromboembolism, was the presenting pathology in this patient’s diagnosis of APS.

  • haematology (incl blood transfusion)
  • haematology (drugs and medicines)
  • adrenal disorders

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  • Contributors ASC provided the majority of the text authorship, including the case, investigations, discussion, and references, as well as image acquisition and ensuring edits occurred for revisions. RJW provided initial editing insights, helping to smooth-out the flow of the whole case report and offered suggestions for improvement while being a resource during the entire process. DS and RB provided further edits regarding the flow of the entire case report, assistance in formulating learning points, making sure data was reported in the correct format, and offering up-to-date sources on new information regarding antiphospholipid syndrome.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.