CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1632069
This article is part of the Research TopicCase Reports in Autoimmune and Autoinflammatory Disorders: Volume IIView all 12 articles
Case Report：Bilateral Adrenal Hemorrhage in a Patient with Systemic Lupus Erythematosus and Antiphospholipid Syndrome
Provisionally accepted
- 1Department of Emergency Internal Medicine, Weifang People’s Hospital, Weifang, Shandong, China
- 2Department of Rheumatology, Weifang People’s Hospital, Weifang, Shandong Province, China
- 3Yidu Central Hospital of Weifang, Weifang, Shandong Province, China
- 4Department of Urology, Qingzhou Traditional Chinese Medicine Hospital, Weifang, China
- 5Beijing University of Chinese Medicine, Beijing, Beijing Municipality, China
- 6School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China
- 7Department of Rheumatology and Immunology, International Hospital, Peking University, Beijing, China
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This case report describes a rare and life-threatening complication of bilateral adrenal hemorrhage (AH) in a 15-year-old female with overlapping systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The patient presented with prolonged abdominal pain, low-grade fever, and lower limb pain. Imaging revealed bilateral adrenal hemorrhages, while laboratory investigations confirmed triple-positive antiphospholipid antibodies (ACA-IgG, ACA-IgM, anti-β2 glycoprotein I) and SLE-related serological markers. Management involved dual-pathway therapy: immunosuppression (prednisone, hydroxychloroquine) for SLE and anticoagulation (low-molecularweight heparin, warfarin) for APS. Despite initial improvement, adrenal insufficiency developed, requiring glucocorticoid replacement. Follow-up demonstrated stabilized clinical status and reduced adrenal lesions. This case underscores the diagnostic challenges of AH in SLE-APS overlap and emphasizes the necessity of combining immunosuppressive and anticoagulant therapies to address both autoimmune inflammation and thrombotic risks. Early recognition and multidisciplinary management are critical to prevent adrenal crisis and improve outcomes in such complex autoimmune-thrombotic pathologies.
Keywords: systemic lupus erythematosus, Antiphospholipid Syndrome, Bilateral adrenal hemorrhage, Adrenal Insufficiency, Thrombosis
Received: 20 May 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Wang, Jin, Pang, Ju, Nie, Gao, Ming and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Li Ming, Department of Rheumatology, Weifang People’s Hospital, Weifang, Shandong Province, China
Sheng-Guang Li, Department of Rheumatology and Immunology, International Hospital, Peking University, Beijing, China
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