This is in response to a recently reported case of splenic
infarction due to vivax malaria [1]. We had a similar child,
who on further evaluation was found to have an elevated
titer of antiphospholipid IgM. We managed the child with low
molecular weight heparin followed by oral warfarin.
In recent years, the association between
infections and antiphospholipid syndrome has been reported
in several epidemiologic and experimental studies that
support the idea of infectious induction of aPL [2].
Witmer, et al. [3] reported two children with
Mycoplasma pneumoniae pulmonary infection complicated by
the development of splenic infarction and transient
antiphospholipid antibodies. Among parasitic infections,
malaria and leishmaniasis have been linked with the
production of aPL. Avcin and Toplak [4]
reviewed 100 antiphospholipid syndrome cases associated with
infection and summarized clinical and experimental evidence
on the association between aPL and infectious diseases, they
also emphasized a possible association with immunizations.
Consigny, et al. [5] found a high prevalence of serum
cofactor independent aCL, which is a type of
antiphospholipid antibody in 137 individuals chronically
exposed to Plasmodium falciparum or vivax
infections.
We opine that antiphosholipid antibodies
should be done in all unusual cases of thrombosis. Anti-phospolipid
antibodies usually take 3-6 months to disappear, till that
time the patients should be on anticoagulant prophylaxis.
1. Tamaria KC, Agarwal S. Splenic
infarction in P.vivax malaria. Indian Pediatr.
2013;50:886.
2. Cervera R, Asherson RA, Acevedo ML.
Antiphospholipid syndrome associated with infections:
clinical and microbiological characteristics of 100
patients. Ann Rheum Dis. 2004;63:1312-7.
3. Witmer CM, Steenhoff AP, Shah SS,
Raffini LJ. Mycoplasma pneumoniae, splenic infarct, and
transient antiphospholipid antibodies: a new association?
Pediatrics. 2007;119:292-5.
4. Avcin T, Toplak N. Antiphospholipid
antibodies in response to infection. Curr Rheumatol Rep.
2007;9:212-8.
5. Consigny PH, Cauquelin B, Agnamey P. High prevalence
of co-factor independent anticardiolipin antibodies in
malaria exposed individuals. Clin Exp Immunol.
2002;127:158-64.