重壘症候群病人合併抗磷脂抗體陽性及腦血管瘤破裂－－病例報告

Ruptured Cerebral Aneurysm in a Patient with Overlap Syndrome and Positive Antiphospholipid Antibody-- A Case Report

一60歲女性病人經診斷為類風濕性關節炎及紅斑狼瘡之重疊症候群，在住院期間發生嚴重頭痛及頸部僵硬。腦部電腦斷層檢查，發現腦室內出血，蜘蛛腦膜下出血及水腦症。隨後之腦血管攝影檢查顯示有多處血管狹窄，擴張及多發性腦血管瘤。紅斑性狼瘡患者發生腦血管瘤破裂引起蜘蛛腦膜下出血並不多見，且僅一例合併有陽性抗磷脂抗體之報告。類風濕性關節炎病患在文獻上也未曾有合併腦血管瘤之報告。我們在此發表一例重疊症候群患者合併陽性抗磷脂抗體及腦血管瘤破裂。

A 60-year-old female with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) overlap syndrome developed severe headache with neck stiffness. Cranial computed tomographic scan showed intraventricular hemorrhage, subarachnoid hemorrhage and hydrocephalus. Bilateral carotid and left vertebral angiography revealed segmental narrowing, dilatation and multiple aneurysms in intracranial arterioles. Subarachnoid hemorrhage due to a ruptured berry aneurysm is rare in SLE patients and antiphospholipd antibody (APLA) present in this condition has only one case been reported. There was no report of cerebral aneurysms in RA either in the literature. We herein report a case of overlap syndrome (SLE + RA) with positive anticardiolipin antibody and ruptured cerebral aneurysm.