PMID- 30921233
OWN - NLM
STAT- MEDLINE
DCOM- 20190404
LR  - 20220408
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 13
DP  - 2019 Mar
TI  - Primary antiphospholipid syndrome during aromatase inhibitors therapy: A case 
      report and review of the literature.
PG  - e15052
LID - 10.1097/MD.0000000000015052 [doi]
LID - e15052
AB  - RATIONALE: Aromatase inhibitors (AIs) are a class of drugs widely used in the 
      treatment of estrogen sensitive breast and ovarian cancer which convert 
      testosterone to estradiol and androstenedione to estrogen. The AIs of third 
      generation, including anastrazole, letrozole and exemestane, have actually become 
      the standard of care of estrogen-receptor-positive breast cancer in menopausal 
      women and are recommended as adjuvant treatment after surgery in place of/or 
      following tamoxifen. Their main side-effects include reduction in bone mineral 
      density, occurrence of menopausal manifestations and development of 
      musculoskeletal symptoms which are, usually, transient, but sometimes evolve into 
      a typical form of arthritis, such as rheumatoid arthritis (RA). Recently, a 
      pathogenic linkage with other autoimmunity diseases, such as Sjogren syndrome 
      (SjS), anti-synthetase antibody syndrome (ASAS), systemic sclerosis (SS) and 
      subacute cutaneous lupus erythematosus (SCLE), was also described. PATIENT 
      CONCERNS: Here, we report the first case of a patient with primary 
      antiphospholipid syndrome (APS) developed during treatment with anastrazole. 
      DIAGNOSIS: The patient developed a sudden onset of speech disturbance and 
      disorientation, due to ischemic lesions, after 6 months of AIs therapy and the 
      laboratory examination showed the positivity of anti-Cardiolipin antibodies, 
      anti-beta2 Glycoprotein 1 antibodies and Lupus Anticoagulant, so a certain diagnosis 
      of APS was achieved. INTERVENTIONS: The patient was treated with warfarin 
      associated to hydroxychloroquine and monthly cycles of low doses intravenous 
      immunoglobulins. OUTCOMES: A good control of the disease was obtained despite the 
      continuation of anastrazole; the patient's clinical and laboratory situation 
      remained not modified after AIs withdrawal. LESSONS: We discussed the possible 
      role of anastrazole treatment in inducing APS in our patient, reporting the 
      available literature data about the association between AIs treatment and 
      autoimmune diseases. Furthermore, we analyzed the mechanism of action of 
      estrogens in the pathophysiology of autoimmune rheumatic disorders.
FAU - Tenti, Sara
AU  - Tenti S
AD  - Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda 
      Ospedaliera Universitaria Senese.
FAU - Giordano, Nicola
AU  - Giordano N
AD  - Scleroderma Unit, Department of Medicine, Surgery and Neurosciences, University 
      of Siena, Policlinico Le Scotte, Viale Bracci 1.
FAU - Cutolo, Maurizio
AU  - Cutolo M
AD  - Research Laboratory and Academic Division of Clinical Rheumatology, Department of 
      Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, 
      Genoa.
FAU - Giannini, Fabio
AU  - Giannini F
AD  - Neurology and Neurophysiology Unit, Department of Medicine, Surgery and 
      Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, Siena, 
      Italy.
FAU - Fioravanti, Antonella
AU  - Fioravanti A
AD  - Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda 
      Ospedaliera Universitaria Senese.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antineoplastic Agents, Hormonal)
RN  - 0 (Aromatase Inhibitors)
RN  - 2Z07MYW1AZ (Anastrozole)
SB  - IM
MH  - Anastrozole/*adverse effects
MH  - Antineoplastic Agents, Hormonal/*adverse effects
MH  - Antiphospholipid Syndrome/*chemically induced
MH  - Aromatase Inhibitors/*adverse effects
MH  - Breast Neoplasms/*drug therapy
MH  - Female
MH  - Humans
MH  - Middle Aged
PMC - PMC6455664
COIS- The authors declare that there is no conflict of interest that could be perceived 
      as prejudicing the impartiality of the research reported.
EDAT- 2019/03/29 06:00
MHDA- 2019/04/05 06:00
PMCR- 2019/03/15
CRDT- 2019/03/29 06:00
PHST- 2019/03/29 06:00 [entrez]
PHST- 2019/03/29 06:00 [pubmed]
PHST- 2019/04/05 06:00 [medline]
PHST- 2019/03/15 00:00 [pmc-release]
AID - 00005792-201903290-00059 [pii]
AID - MD-D-18-08291 [pii]
AID - 10.1097/MD.0000000000015052 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Mar;98(13):e15052. doi: 10.1097/MD.0000000000015052.