炔雌醇环丙孕酮片诱发抗磷脂综合征患者下肢深静脉血栓和亚急性肺栓塞

Ethinylestradiol and cyproterone acetate tablets‑induced deep vein thrombosis complicated with subacute pulmonary embolism in a patient with antiphospholipid syndrome

1例16岁女性患者因月经不调给予炔雌醇环丙孕酮片(1片/d口服,连服21 d)行月经人工周期治疗。用药第7天患者出现右下肢远端肿胀,伴疼痛,活动轻度受限,未引起注意。21 d后停药。停药第2天患者出现阴道撤退性出血,同日出现咳痰带血1次。停药16 d后患者右下肢肿胀和疼痛加重,超声检查示右下肢深静脉血栓形成,肺动脉CT血管成像示右下肺动脉栓塞。诊断为右下肢深静脉血栓,亚急性肺栓塞,给予依诺肝素钠抗凝及对症治疗,17 d后症状好转。实验室检查示血小板计数90×10^(9)/L,抗心磷脂抗体IgG 209 GPL/ml,血小板相关抗体阳性,诊断为抗磷脂综合征。考虑患者的血栓形成与炔雌醇环丙孕酮片有关。

A 16⁃year⁃old female patient received ethinylestradiol and cyproterone acetate tablets(1 tablet once daily for 21 days)for artificial menstrual cycle treatment due to irregular menstruation.On the 7th day of medication,the patient developed swelling of the distal right lower extremity,accompanied by pain,and slight limitation of movement,which did not attract attention.The drug was stopped 21 days later.On the 2nd day after drug withdrawal,the patient had vaginal withdrawal bleeding and blood expectoration occurred once on the same day.After 16 days of drug withdrawal,the swelling and pain of the right lower limb was aggravated.Ultrasound showed deep vein thrombosis in the right lower limb,and CT angiography of the pulmonary artery showed embolism in the right lower pulmonary artery.Deep vein thrombosis complicated with subacute pulmonary embolism were diagnosed.Enoxaparin sodium for anticoagulation and symptomatic treatments were given,the symptoms were improved 17 days later.Laboratory tests showed that the platelet count was 90×10^(9)/L,the anticardiolipin antibody IgG was 209 GPL/ml,and the platelet⁃related antibody was positive.Antiphospholipid syndrome was diagnosed.It was considered that the thrombosis was related to ethinylestradiol and cyproterone acetate tablets.