Atypical Manifestation of Primary Antiphospholipid Syndrome: Conservative Management of Celiac Trunk Thrombosis Case Report and Literature Review

Aortic and celiac trunk thrombosis is an exceptional manifestation of antiphospholipid syndrome (APS). A 36-year-old woman with triple-positive APS, prior ischemic strokes, and chronic hypertension discontinued her anticoagulation therapy with acenocoumarin 1 week before presenting sudden, severe, transfixing epigastric and mesogastric pain radiating to the back, nausea, vomiting, and hypertension (174/118 mmHg). Initial tests showed anemia (9.8 g/dL), leukocytosis, elevated LDH, and an INR of 1.44. The abdominal CT angiography revealed an aortic stenosis of 54% caused by a thrombus extending into the celiac trunk (95% stenosis) and subacute splenic infarction. Anticoagulation was resumed alongside analgesia. One week later, celiac stenosis reduced to 44%. She was discharged on enoxaparin, hydroxychloroquine, and nifedipine. After 1 month, blood pressure was controlled, and a small residual aortic thrombus persisted without celiac trunk thrombosis evidence. This case highlights the importance of early recognition of APS and its complications, including rare vascular manifestations, and illustrates the potential role of conservative treatment in managing the rare vascular manifestation of APS, where standardized treatment guidelines are lacking.