When One Antibody Disappears, and Others Emerge: A Six-Year Evolution of Antiphospholipid Antibodies in a Pregnant Woman with Systemic Lupus Erythematosus

CASE REPORT
Ina Toska, Rexhep Shkurti, Ervin Rapushi, Anila Mitre

 

For citation: Toska I, Shkurti R, Rapushi E, Mitre A. When One Antibody Disappears, and Others Emerge: A Six-Year Evolution of Antiphospholipid Antibodies in a Pregnant Woman with Systemic Lupus Erythematosus. International Journal of Biomedicine. 2026;16(3):395-397. doi:10.21103/Article16(3)_CR2

Originally published September 5, 2026

Abstract: 

Antiphospholipid antibodies (aPL) are frequently detected in patients with systemic autoimmune diseases, particularly in systemic lupus erythematosus (SLE), and are associated with thrombotic events and adverse pregnancy outcomes. Although persistent aPL positivity is crucial for antiphospholipid syndrome (APS) classification, increasing evidence suggests that aPL profiles may evolve over time. Longitudinal observations documenting the transition between antiphospholipid antibody specificities remain limited.
We report the case of a 33-year-old woman with SLE diagnosed in 2019, who initially presented with persistent high-titer anti-β2GPI IgM (confirmed on repeat testing after 12 weeks) positivity. Lupus anticoagulant (LAC) and anti-β2GPI IgG were initially negative. During her first pregnancy in 2024, anti-β2GPI antibodies became negative, while LAC activity increased from 42.3 to 48.3 sec and anticardiolipin IgM antibodies became positive (60.6 U/mL). The pregnancy resulted in a preterm birth at 36 weeks of gestation. During the second pregnancy, in March 2026, LAC activity further increased to 55.1 sec, and both aCL IgM and IgG antibodies became positive. Throughout the six-year follow-up period, the patient remained free of arterial or venous thrombotic events and remained on stable treatment with hydroxychloroquine, methylprednisolone, and low-dose aspirin.
This case demonstrates a remarkable longitudinal evolution of the aPL profile in a woman with SLE, characterized by the disappearance of high-titer anti-β2GPI IgM antibodies and subsequent emergence of LAC and aCL antibodies. These findings emphasize the dynamic nature of antiphospholipid autoimmunity and support the importance of long-term monitoring of aPL profiles in patients with SLE, particularly during reproductive years.

Keywords: 
antiphospholipid antibodies • lupus anticoagulant • aCL antibodies • systemic lupus erythematosus
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Received July 1, 2026.
Accepted August 6, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC. This is an open access article under the CC BY-NC-ND 4.0 license.