A Rare Case of Antiphospholipid Syndrome (APLS) Presented as Bilateral Adrenal Hemorrhage

Abstract

A 37-year-old man presented with bilateral adrenal hemorrhage, an uncommon clinical scenario often linked to conditions such as antiphospholipid syndrome (APLS). He reported experiencing lower and bilateral abdominal pain for one week, along with symptoms indicative of an adrenal crisis. Subsequent investigations revealed a significantly low AM cortisol level of 67 nmol/L, and a CT scan of the abdomen confirmed bilateral adrenal hemorrhage. The patient tested positive for anti-cardiolipin, anti-Beta 2 glycoprotein, and lupus anticoagulant, affirming the diagnosis of APLS. Treatment with glucocorticoid and mineralocorticoid replacement led to clinical improvement. This case underscores the importance of maintaining a high index of suspicion for APLS in patients presenting with unexplained abdominal pain, with or without adrenal crisis symptoms, as bilateral adrenal hemorrhage can be a rare but serious manifestation. The CT scan remains a crucial diagnostic tool in detecting such hemorrhages.