Chorea Associated with High Titers of Antiphospholipid Antibodies in the Absence of Antiphospholipid Antibody Syndrome

Damoun Safarpour; Sarah Buckingham; Bahman Jabbari

doi:10.5334/tohm.250

Abstract

Background: Chorea associated with high titers of antiphospholipid antibodies in the absence of antiphospholipid antibody syndrome has been seldom reported.

Case report: An 89-year-old female developed persistent right side chorea associated with high titers of anticardiolipin antibody (antiphospholipid antibosies immunoglobulin (Ig)M, 45 MPL and 112 IgM aCL (MPL) after 3 months) but normal lupus anticoagulants. Her magnetic resonance imaging (MRI) showed no abnormality, but positron emission tomography (PET) demonstrated increased bilateral striatal metabolic activity, more on the left side. Her MRI showed no cause for chorea. The PET scan demonstrated a marked increase in the metabolic activity of the left basal ganglia.

Discussion: Her chorea remained unchanged over a 9-month follow-up period. The literature on chorea associated with high titers of antiphospholipid antibodies in the absence of antiphospholipid syndrome is reviewed.

References

WalkerRHDifferential diagnosis of choreaCurr Neurol Neurosci Rep20111138539510.1007/s11910-011-0202-221465146
Open DOI Search in Google Scholar Back to article
MiyasakiJMChorea caused by toxinsHandb Clin Neurol201110033534610.1016/B978-0-444-52014-2.00026-421496593
Open DOI Search in Google Scholar Back to article
PandeySChoreaJ Assoc Physicians India2013614714, 483Review24772751
Search in Google Scholar Back to article
BhidayasiriRTruongDDChorea and related disordersPostgrad Med J20048052753410.1136/pgmj.2004.01935615356354
Open DOI Search in Google Scholar Back to article
ViglianiMCHonnoratJAntoineJCet alPNS EuroNetwork. Chorea and related movement disorders of paraneoplastic origin: The PNS EuroNetwork experienceJ Neurol20112582058206810.1007/s00415-011-6074-121559939
Open DOI Search in Google Scholar Back to article
ShiWKrilisSAChongBHGordonSChestermanCNPrevalence of lupus anticoagulant and anticardiolipin antibodies in a healthy populationAust NZ J Med19902023123610.1111/j.1445-5994.1990.tb01025.x
Open DOI Search in Google Scholar Back to article
VilaPHernándezMCLópez-FernándezMFBatlleJPrevalence, follow-up and clinical significance of the anticardiolipin antibodies in normal subjectsThromb Haemost1994722092137831653
Search in Google Scholar Back to article
VaaralaOPalosuoTKleemolaMAhoKAnticardiolipin response in acute infectionsClin Immunol Immunopathol19864181510.1016/0090-1229(86)90046-23742889
Open DOI Search in Google Scholar Back to article
SnowdenNWilsonPBLongsonMPumpheryRSAntiphospholipid antibodies and Mycoplasma pneumoniae infectionPostgrad Med J19906635636210.1136/pgmj.66.775.3562371184
Open DOI Search in Google Scholar Back to article
AvcinTToplakNAntiphospholipid antibodies in response to infectionCurr Rheumatol Rep2007921221810.1007/s11926-007-0034-x17531174
Open DOI Search in Google Scholar Back to article
BickRLBakerWFAntiphospholipid and thrombosis syndromeSemin Thromb Hemost19942031510.1055/s-2007-10018858059232
Open DOI Search in Google Scholar Back to article
MiyakisSLockshinMDAtsumiTet alInternational consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)J Thromb Haemost2006429530610.1111/j.1538-7836.2006.01753.x16420554
Open DOI Search in Google Scholar Back to article
SannaGBertolacciniMLCuadradoMJet alNeuropsychiatric manifestations in systemic lupus erythematosus: Prevalence and association with antiphospholipid antibodiesJ Rheumatol20033098599212734893
Search in Google Scholar Back to article
CerveraRAshersonRAFontJet alChorea in the antiphospholipid syndrome. Clinical, radiologic, and immunologic characteristics of 50 patients from our clinics and the recent literatureMedicine (Baltimore)19977620321210.1097/00005792-199705000-000069193455
Open DOI Search in Google Scholar Back to article
AlbishriJAChorea as a first manifestation in young patients with systemic lupus erythematosus who was initially diagnosed with rheumatic feverClin Med Insights Case Rep20125192110.4137/CCRep.S914322408372
Open DOI Search in Google Scholar Back to article
IqbalSSherMRGoodRACawkwellGDDiversity in presenting manifestations of systemic lupus erythematosus in childrenJ Pediatr199913550050510.1016/S0022-3476(99)70174-510518085
Open DOI Search in Google Scholar Back to article
ArisakaOObinataKSasakiHArisakaMKanekoKChorea as an initial manifestation of systemic lupus erythematosus. A case report of a 10-year-old girlClin Pediatr (Phila)19842329830010.1177/0009922884023005146705440
Open DOI Search in Google Scholar Back to article
AriizumiYOzawaTTokutakeTet alChorea as the first sign in a patient with elderly-onset systemic lupus erythematosusCase Rep Neurol Med2012201231708222953090
Search in Google Scholar Back to article
TarrTLakosGBhattoaHPet alClinical thrombotic manifestations in SLE patients with and without antiphospholipid antibodies: A 5-year follow-upClin Rev Allergy Immunol20073213113710.1007/s12016-007-0009-817916982
Open DOI Search in Google Scholar Back to article
PelusoSAntenoraADe RosaAet alAntiphospholipid-related choreaFront Neurol2012315010.3389/fneur.2012.0015023097646
Open DOI Search in Google Scholar Back to article
AshersonRANew subsets of the antiphospholipid syndrome in 2006: “PRE-APS” (probable APS) and microangiopathic antiphospholipid syndromes (“MAPS”)Autoimmun Rev20066768010.1016/j.autrev.2006.06.00817138247
Open DOI Search in Google Scholar Back to article
CarecchioMComiCVarrasiCet alComplex movement disorders in primary antiphospholipid syndrome: A case reportJ Neurol Sci2009Jun 1528110110310.1016/j.jns.2009.03.01119344915
Open DOI Search in Google Scholar Back to article
GelosaGTremolizzoLGalbusseraAet alNarrowing the window for ‘senile chorea’: A case with primary antiphospholipid syndromeJ Neurol Sci2009Sep 1528421121310.1016/j.jns.2009.05.00919467547
Open DOI Search in Google Scholar Back to article
SchmidtRAuer-GrumbachPFazekasFOffenbacherHKapellerPAnticardiolipin antibodies in normal subjects. Neuropsychological correlates and MRI findingsStroke19952674975410.1161/01.STR.26.5.7497740561
Open DOI Search in Google Scholar Back to article
AshersonRAHughesGRVAntiphospholipid antibodies and choreaJ Rheumatol1988153773793361549
Search in Google Scholar Back to article
LevineSRBreyLRNeurological aspects of antiphospholipid antibody syndromeLupus199653473538902759
Search in Google Scholar Back to article
ChapmanJCohen-ArmonMShoenfeldYKorczynADAntiphospholipid antibodies permeabilize and depolarize brain synaptoneurosomesLupus1999812713310.1191/09612039967884752410192507
Open DOI Search in Google Scholar Back to article
WuSWGrahamBGelfandMJGruppoREDinopolousAGilbertDLClinical and positron emission tomography findings of chorea associated with primary antiphospholipid syndromeMovement disorders2007221813181510.1002/mds.2165717659641
Open DOI Search in Google Scholar Back to article
Kiechl-KohlendorferUEllemunterHKiechlSChorea as the presenting clinical feature of primary antiphospholipid syndrome in childhoodNeuropediatrics199930969810.1055/s-2007-97346810401693
Open DOI Search in Google Scholar Back to article
UsugiTNakanoKNakayamaTIshiiKOsawaMFamilial antiphospholipid antibody in a child with involuntary movement and deteriorationPediatr Int20074923824110.1111/j.1442-200X.2007.02346.x17445046
Open DOI Search in Google Scholar Back to article
Biernacka-ZielinskaMLipinskaJSzymanska-KaluzaJStanczykJSmolewskaERecurrent arterial and venous thrombosis in a 16-year-old boy in the course of primary antiphospholipid syndrome despite treatment with low-molecular-weight heparin: A case reportJ Med Case Rep2013722110.1186/1752-1947-7-22123971759
Open DOI Search in Google Scholar Back to article
ShimomuraTTakahashiSTakahashiSChorea associated with antiphospholipid antibodiesRinsho Shinkeigaku19923298993[in Japanese]1300273
Search in Google Scholar Back to article
Sundén-CullbergJTedroffJAquiloniusSMReversible chorea in primary antiphospholipid syndromeMov Disord199813147149Review10.1002/mds.8701301279452340
Open DOI Search in Google Scholar Back to article
OrzechowskiNMWolanskyjAPAhlskogJEKumarNModerKGAntiphospholipid antibody-associated choreaJ Rheumatol2008352165217010.3899/jrheum.08026818925689
Open DOI Search in Google Scholar Back to article

Chorea Associated with High Titers of Antiphospholipid Antibodies in the Absence of Antiphospholipid Antibody Syndrome

Abstract

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