2023 Volume 45 Issue 4 Pages 317-323
We report a case of a 60-year-old woman presenting with recurrent vascular events associated with pseudoxanthoma elasticum (PXE). The patient had a history of myocardial infarction that was treated with percutaneous coronary intervention for 10 years and had been treated with oral antiplatelet (clopidogrel) 3 years after a diagnosis of perforator infarction. She was transferred to our hospital after a sudden onset of left hemiparesis and dysarthria. MRI indicated acute perforator infarction at the right coronal radiation and multiple old infarctions at the bilateral basal ganglia. Major artery stenosis or occlusion was not observed on MR angiography (MRA). Biochemical examinations, such as those for d-dimer, proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA), myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), protein C/S, lupus anticoagulant, and anti-cardiolipin immunoglobulin, were normal. Physical examinations investigating the recurrent vascular events revealed yellowish papules at the posterior region of the neck and fundus hemorrhage. The diagnosis of PXE was made accordingly. Treatment with oral antiplatelet with acetylsalicylic acid replacing clopidogrel was continued. It is particularly important to keep in mind the identification of PXE in nonelderly patients with recurrent perforator infarction, for the management of concurrent disorders.
