Physicians reported the case of a patient diagnosed with arterial thrombosis secondary to cold agglutinin disease (CAD) in the Annals of African Medicine.
Arterial thrombosis can occur secondary to CAD, especially if there is an existing Mycoplasma pneumoniae infection. Although arterial thrombosis predisposes a patient to cerebrovascular incidents, stroke is very rare.
The case study as presented by Paneyala and colleagues details a 22-year-old female who presented with left-sided weakness and slurred speech, which had been present for 1 day. She had no known comorbidities but was recently treated for a 5-day cough and fever. She reported being fever free in the 36 hours leading up the onset of her current symptoms.
Upon examination, the patient appeared drowsy but arousable; in addition, her physicians noted a left-sided upper motor neuron-type of facial palsy and left-sided hemiparesis. Magnetic resonance imaging of the brain revealed acute infarcts located in the right fronto-parieto-temporal lobes, thalamus, caudate nucleus, and insular cortex. Thrombosis of the right cerebral artery at the M2, M3, and M4 segments was also observed.
Read more about CAD etiology
The patient was started on antiplatelets and neuroprotective medication. Bloodwork revealed mild hemolytic anemia. A chest X-ray revealed left-sided pleural effusion and a pleural tap was performed that revealed lymphocytic pleocytosis with elevated protein levels. Broad-spectrum antibiotics with atypical coverage were initiated.
A Coombs test was ordered, which returned positive. The patient was then started on pulse methylprednisolone.
On hospital day 3, the patient suddenly developed tachycardia and tachypnea. D-dimers were elevated. Computed tomographic pulmonary angiogram revealed evidence of thromboembolism in the peripheral pulmonary arteries. Venous Doppler of the lower limbs ruled out a peripheral cause.
The patient’s physicians initiated a workup for possible secondary causes of hemolytic anemia induced by cold agglutinins. An antinuclear antibody profile, lupus anticoagulants, and antiphospholipid antibodies were negative.
“In view of the background history of fever, immunoglobulin M mycoplasma levels were sent, which were found to be significantly elevated,” the authors wrote. “Hence, a diagnosis of mycoplasma pneumonia associated with cold agglutinin-induced hemolytic anemia was made.”
The patient was duly prescribed pulse steroids and atypical antibiotics coverage. The room was maintained as closely as possible at ambient room temperature.
The patient soon stabilized and was discharged on oral steroids and anticoagulants.
Paneyala S, Nemichandra SC, Sundaramurthy H, Colaco KVC. Dual arterial thrombosis: a diagnostic enigma. Ann Afr Med. 2022;21(3):291-295. doi:10.4103/aam.aam_96_20