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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 188-190

EXPERIENCE AND REASON

Anti-ß2-Glycoprotein I Antibodies and Ischemic Stroke in a 20-Month-Old Boy

Eustathia Katsarou, MD, Achilleas Attilakos, MD, Smaragdi Fessatou, MD, Heleni Tsapra, MD, Vasiliki Tzavara, MD and Christina Dracou, MD

Department of Neurology
Panagiotis and Aglaïa Kyriakou Children’s Hospital
Athens, 11527 Greece
Second State Department of Pediatrics
Panagiotis and Aglaïa Kyriakou Children’s Hospital
Athens, 11527 Greece
Immunology Department
General Hospital of Athens
Athens, Greece
Second State Department of Pediatrics and Outpatient Pediatric Rheumatology Clinic
Panagiotis and Aglaïa Kyriakou Children’s Hospital
Athens, 11527 Greece

Antibodies to ß2-glycoprotein I (anti-ß2GPI) have been associated with recurrent thrombosis and pregnancy morbidity. However, the prevalence of anti-ß2GPI in children suffering from cerebral infarction is unknown. We report on a 20-month-old boy who had an ischemic stroke, secondary to antiphospholipid syndrome with high titers of immunoglobulin G anti-ß2GPI (first titer: 132 U; second titer 6 weeks later: 350 U; normal range: 0–100 U). Anticardiolipin antibodies and lupus anticoagulant tests were negative. All other causes of infarction were excluded. Laboratory studies showed anti-ß2GPI IgG levels of 164 U and 216 U at 6 months and 2 years, respectively, after the onset. The patient received treatment with low-dose aspirin. To our knowledge, this is the first reported case of childhood ischemic stroke with only anti-ß2GPI but no antibodies detectable in standard antiphospholipid assays. This case supports the recommendation of others to search for these antibodies in the presence of strong clinical suspicion of antiphospholipid syndrome, when anticardiolipin antibodies and lupus anticoagulant tests are negative.

Key Words: anti-ß2GPI • stroke • antiphospholipid syndrome • children

Abbreviations: aPLs, antiphospholipid antibodies • aCLs, anticardiolipin antibodies • LA, lupus anticoagulant • anti-ß2GPI, anti-ß2-glycoprotein I antibodies • MRI, magnetic resonance imaging • IgM, immunoglobulin M • IgG immunoglobulin G • ELISA, enzyme-linked immunosorbent assay • APS, antiphospholipid syndrome

Received for publication Nov 4, 2002; Accepted Apr 1, 2003.




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M.-C. Boffa and E. Lachassinne
Review: Infant perinatal thrombosis and antiphospholipid antibodies: a review
Lupus, August 1, 2007; 16(8): 634 - 641.
[Abstract] [PDF]