Ischemic Stroke as the First Manifestation of Primary Antiphospholipid Syndrome in a Patient With a Recent Diagnosis of HIV: A Case Report

The importance of stroke in young adults lies in the clinical challenge it represents, because of the frequent association with uncommon causes and non-atherosclerotic causes, such as the antiphospholipid syndrome (APS). This last one plays a very important role in strokes in this population, especially in patients with the absence of conventional vascular risk. We report a 34-year-old male adult with no prior history of thrombotic events or cardiovascular risk factors, who started with focal neurological symptoms. Many studies were performed; a simple coronal skull computed tomography scan revealed ischemic infarction in the right parietal lobe, and there was no evidence of significant atheromatous plaque or heart defects. Due to the suspicion of a prothrombotic state, laboratory studies were performed, revealing positivity for lupus anticoagulant (LA) and immunoglobulin (IgG) anticardiolipin antibodies, supporting the diagnosis of primary APS. Further viral serological testing confirmed previously undiagnosed human immunodeficiency virus infection (HIV). The patient was managed with antiretroviral therapy, statins, antiplatelet, prophylactic antibiotics, and physical rehabilitation, showing significant improvement. This case highlights the importance of the early and accurate etiology diagnosis on a population that may represent a challenge to diagnose, in this case we could see how the stroke was linked with the APS and the HIV, and how timely and appropriate management can significantly influence prognosis and reduce the risk of recurrent prothrombotic events.