Coexistence Between Antiphospholipid Syndrome and Protein S Deficiency in a Patient With Transverse Sinus Thrombosis: A Rare Association

The primary antiphospholipid syndrome and protein S deficiency are known hypercoagulable states predisposing to strokes. We present a 34-year-old woman presented to rheumatology clinic complaining of right side weakness and aphasia for 2 months before the visit. There was joint pain in the right elbow and shoulder joints, hyperpigmentation on her face and dry painful red eyes mainly the right eye in addition to dry mouth. She had a history of recurrent abortions. Neurological examination showed hypertonia on right lower and upper limb and normal on left one, while the power was grade 3 on right side and normal in left one. Upper motor neuron signs and facial palsy was noted. Hyperpigmentation in the face was observed. MRI brain showed that left temporoparietal hemorrhagic infraction involving the basal ganglia and MRV brain showed left transverse sinus thrombosis and attenuation of sigmoid and internal jugular vein. B2-glycoprotein Ig AGM, lupus anticoagulant, anticardiolipin (IgG, IgM, and IgA), protein S were positive. ANA profile was borderline for PCNA. We report unusual venous sinus thrombosis with primary antiphospholipid syndrome and acquired protein S deficiency.