Dual arterial thrombosis: A diagnostic enigma

• Published in: Annals of African medicine Vol. 21; no. 3; pp. 291 - 295
• Main Authors: Paneyala, Shasthara, Nemichandra, S, Sundaramurthy, Harsha, Colaco, K
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-07-2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow
• Subjects: Adult; Anemia, Hemolytic - complications; Anemia, Hemolytic, Autoimmune - complications; Antibiotics; Anticoagulants; Autoimmune diseases; Azithromycin; Bacterial pneumonia; Blood clot; Blood diseases; Case Report; Case reports; Development and progression; Diagnosis; Diagnostic imaging; Doxycycline; Erythrocytes; Fever; Health aspects; Hemoglobin; Hemoglobins; Hemolysis; Humans; Hyperthermia; Immunoglobulin M; Ischemia; Medical diagnosis; Pneumonia; Stroke; Thrombosis; Thrombosis - complications; Thrombosis - diagnostic imaging; Thrombosis - drug therapy; Young Adult; pulmonary thrombosis; Cold agglutinin disease; ischemic stroke
• ISSN: 1596-3519; 0975-5764
• DOI: 10.4103/aam.aam_96_20

Cold agglutinin disease is a rare cause of arterial thrombosis leading to stroke, commonly encountered against a background of mycoplasma pneumonia infections. A 22-year-old patient presented with acute-onset left hemiplegia preceded by a short history of fever and cough. Magnetic resonance imaging (MRI) showed a right middle cerebral artery infarct. Serially repeated hemoglobin levels showed a progressive drop and peripheral smear showed evidence of hemolysis. Blood drawn for investigations would rapidly clot, suggesting a possibility of cold agglutinin-induced hemolysis. The patient was then worked up for all the possible causes of hemolytic anemia including secondary causes which were all negative except for significant immunoglobulin M mycoplasma levels with elevated cold antibody titers. The patient was then initiated on pulse steroids with azithromycin and doxycycline and hemoglobin levels stabilized. The patient also developed pulmonary thromboembolism which was managed with anticoagulation. The patient made a steady improvement, was discharged, and is on follow-up. Here, we present a unique case of mycoplasma associated cold agglutinin disease causing arterial thrombosis.