Severe digital ischemia coexists with thrombocytopenia in malignancy-associated antiphospholipid syndrome: A case report and review of literature

Table 1 Main laboratory values in the present case

Item	Laboratory value	Reference value
RBC (1012/L)	3.68	3.8-5.1
WBC (109/L)	6.81	3.5-9.5
Platelet count (109/L)	41	150-450
D-dimer (mg/L)	0.82	< 0.55
Prothrombin time (s)	11.1	9.6-12.8
Activated partial thromboplastin time (s)	28.2	24.8-33.8
Fibrinogen (g/L)	2.82	2.0-4.0
International normalized ratio	0.98	0.88-1.15
Serum C-reactive protein (mg/L)	4.77	< 5
ESR (mm/h)	36	< 38
HIV	Negative	Negative
HBV	Positive	Negative
Syphilis	Negative	Negative
Serum complement C3 (g/L)	0.899	0.785-1.520
Serum complement C4 (g/L)	0.209	0.145-0.360
IgG (g/L)	10.6	8.0-15.5
IgA (mg/L)	950	836-2900
IgM (mg/L)	1240	700-2200
IgG anticardiolipin antibodies (GPLU/mL)	> 120	< 10
IgA anticardiolipin antibodies (APLU/mL)	57	< 10
IgM anticardiolipin antibodies (MPLU/mL)	4.24	< 10
IgG anti-β2 -glycoprotein-I (AU/mL)	> 200	< 20
IgA anti-β2 -glycoprotein-I (AU/mL)	90.1	< 20
IgM anti-β2 -glycoprotein-I (AU/mL)	2	< 20
Antinuclear antibody	+1:100	Negative
Lupus anticoagulant	Negative	Negative
Coombs’ test	Negative	Negative
Carcinoembryonic antigen (ng/mL)	1.87	< 5
α-fetoprotein	> 1210	< 7

RBC: Red blood cell; WBC: White blood cell; ESR: Erythrocyte sedimentation rate; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus.

Table 2 Summary of reported paraneoplastic syndromes of hepatocellular carcinoma

Category	Associated diseases/condition	Ref.
Hematologic syndromes	Severe eosinophilia	Yuen et al[23], 1995
	Hemophagocytic syndrome	Sakai et al[24], 2001
	Erythrocytosis	Tsuchiya et al[25], 2009
	Leukemoid reaction	Shin et al[26], 2011
	Thrombocytosis	Abbas et al[27], 2019
Rheumatologic syndromes	Raynaud's phenomenon	Sahan et al[6], 2006
	Polymyositis	Thanapirom et al[28], 2014
	Dermatomyositis	Chou et al[7], 2017
	Polyarthritis	Sathiyapalan et al[29], 2021
Dermatologic syndromes	Symptomatic porphyria	Ochiai et al[30], 1997
	Disseminated superficial porokeratosis	Kono et al[31], 2000
	Cutaneous lupus erythematosus	Ho et al[32], 2001
	Erythema nodosum	Glinkov et al[33], 2003
	Pemphigus	Yokokura et al[34], 2006
	Generalized granuloma annulare	Cho et al[35], 2018
Endocrine syndromes	Hypercholinesterasemia	Tajiri et al[36], 1983
	Hyperlipidemia	Makino et al[37], 1986
	Hyperestrogenia	Salles et al[38], 1987
	Hyperthyroidism	Carri et al[39], 1989
	Hyperthyroxinemia	Nizam et al[40], 1995
	Carcinoid syndrome	Nwokediuko et al[41], 2010
	Hypercalcemia	Newman et al[5], 2015
	Hyperglycemia	Kim et al[42], 2015
Neurologic or neuropsychiatric syndromes	Necrotizing myelopathy	Misumi et al[43], 1988
	Neurologic manifestations	Norris et al[44], 1997
	Demyelinating polyneuropathy	Walcher et al[45], 2002
	Peripheral neuropathy	Matsui et al[46], 2015
	Neuropsychiatric manifestations	Karam et al[47], 2020
	Hyperammonemic encephalopathy	Lee et al[48], 2021
Miscellaneous syndromes	Hypertension	Arai et al[4], 1999
	Membranous glomerulonephritis	Texier et al[49], 2004
	Nummular loss of the retinal pigment epithelium	Lee et al[50], 2007
	Myasthenia gravis	Vautravers et al[51], 2008
	Rhabdomyolysis	Bárdos et al[52], 2021