Fulminant ecchymosis as the initial manifestation of antiphospholipid syndrome (APS) triggered by respiratory syncytial virus (RSV) infection: A case report and review of the literature

Makino, Jun; Koshy, Sanjana; Bajaj, Sonal; Jeong, Young-Gwang; Perlman, David C.

The FilmArray Respiratory Panel (BioFire) is a new molecular test used to assess responses to panel of 20 respiratory viruses and bacteria [9] . Results are available in several hours and the sensitivity and specificity have been reported to be 100% and 89% respectively [9] . In our patient, the test for RSV was positive but tests for other infectious etiologies previously associated with APS were negative except for EBV. Although acute EBV infection has been associated with APS in the previous case reports [10, 11] , the lack of cervical lymphadenopathy or hepatosplenomegaly and a negative anti b2-GPI made acute EBV infection less likely in our case. In addition, a recent retrospective study found that while the prevalence of aPLs among patients with acute EBV was 37%, none of those with aPLs had any symptoms of APS, and the aPLs resolved in all of those tested [12] . It is plausible however that, within a "twohit" model, this patient may have had a condition associated with aPL antibodies (for instance, EBV or other some other condition which could have accounted for the patient's preceding symptoms of fevers, weight loss, arthralgia, etc.) several months prior to RSV, and the RSV then served as the inflammatory trigger, inducing symptoms of APS.