Síndrome antifosfolípido de debut en la adolescencia con síndrome de Budd-Chiari y colitis isquémica: reporte de un caso pediátrico
DOI:
https://doi.org/10.5281/zenodo.23020398Palabras clave:
vasculopatía gastrointestinal, anticoagulación, vena cava inferior, autoanticuerpos, trombosis venosaResumen
El síndrome antifosfolípido es una trombofilia autoinmune poco frecuente en edad pediátrica y puede debutar con trombosis en territorios inusuales. Se describe la evolución de una adolescente de 14 años y 11 meses con dolor abdominal de un mes, vómitos, deshidratación y choque compensado, en quien el estudio Doppler identificó trombosis del segmento retrohepático de la vena cava inferior, hepatomegalia congestiva y hallazgos compatibles con síndrome de Budd-Chiari. El perfil inmunológico mostró anticoagulante lúpico positivo, anticardiolipina IgM elevada, anti-β2-glicoproteína I IgM positiva, hipocomplementemia y Coombs directo positivo. La evolución incluyó anticoagulación con enoxaparina, trombólisis sistémica con alteplasa, corticoterapia, hidroxicloroquina y rituximab. Ante dolor abdominal persistente, Gastroenterología consideró colitis isquémica en el contexto protrombótico, sin documentarse oclusión mesentérica macroscópica. Los controles evidenciaron reducción y organización del trombo, recuperación hematológica y disminución de la respuesta inflamatoria, con egreso clínicamente estable. El caso evidencia la necesidad de sospechar síndrome antifosfolípido ante trombosis venosa abdominal en adolescentes y de integrar evaluación hematológica, reumatológica, hepatológica, gastrointestinal e imagenológica.
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