Postpartum rheumatological condition?

[badgergal]

I had my first baby 5 months ago, induced 2 weeks early due to pregnancy-induced hypertension and fetal growth restriction. Four days later I noticed I was abnormally short of breath at rest. Then I noticed my heart was racing when I stood up, but would return to normal if I sat or laid down. Over the next couple months I had nearly every test imaginable -- blood tests, CT scan of chest, ECG, Holter, echo, EMG, blood tests galore. Aside from showing consistent tachycardia upon standing, all tests were normal except the thrombophilia tests I had done to explain the growth restriction: I have anticardiolipin antibodies (value of 22) and am positive for a prothrombin genetic mutation that increases clot risk.

Since I had the baby I have endured this constant shortness of breath, developed severe muscle weakness to the point of dropping things and losing coordination, have had intermittant chest pressure & pain, and have swelling in my feet/lower legs that gets better when they're elevated. My blood pressure is now in the normal to "prehypertension" range, and it was always low before all this happened. So far I have seen five doctors; a neurologist was my last stop and he suggested I either have dysautonomia or a rheumatological condition -- perhaps antiphospholipid antibody syndrome. Is this a possibility? I don't believe I have had an ANA titer, either. Could this be some strange form of lupus, or is this all some strange anxiety reaction? I am 28, white, normal weight, exercise 5 days/week, no past medical issues.

[Kevin Pho, MD]

I would suggest being tested rheumatologically.  One or more of the following laboratory tests for the presence of antiphospholipid antibodies or for evidence of their activity as lupus anticoagulants supports the diagnosis:

IgG and IgM anticardiolipin antibodies
Antibody to ß2-glycoprotein I
Lupus anticoagulant

It is a possibility that lupus can be associated with the symptoms - I would certainly add an ANA level as well.  

Given the elevated anticardiolipin antibodies as well as the prothrombin gene mutation, clot risk is definitely increased.  Make sure that your shortness of breath isn't caused by a pulmonary embolus.  I would suggest a V/Q scan or a CT-pulmonary angiogram for further evaluation.  You may want to discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b