Abstract Background Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening variant of antiphospholipid syndrome (APS), characterized by rapid-onset thrombosis affecting multiple organs in the presence of antiphospholipid antibodies (aPL). CAPS is often triggered by an underlying condition, such as infection or malignancy. Early diagnosis and initiation of combination therapy are crucial, given the associated high morbidity and mortality. Case Summary A 74-year-old woman presented with progressive dyspnea and acute right-hand ischemia. Imaging and laboratory work-up revealed widespread arterial and venous thromboses, including pulmonary embolism, brachial artery embolism, carotid artery involvement, and popliteal vein thrombosis. Laboratory tests showed positive lupus anticoagulant, raising suspicion for CAPS. She was treated with intravenous unfractionated heparin, high-dose corticosteroids, and intravenous immunoglobulins. A PET-CT revealed suspected pulmonary adenocarcinoma, which was confirmed via lymph node biopsy. Following initial clinical improvement and discharge on warfarin, she was readmitted with critical limb ischemia and later on she suffered an ischemic stroke. Despite endovascular interventions, her condition deteriorated. Given her poor prognosis and ineligibility for oncologic therapy, comfort care was initiated. The patient passed away a few days later. Conclusion This case highlights the diagnostic and therapeutic challenges of probable CAPS in the context of occult malignancy. CAPS should be considered in patients presenting with simultaneous arterial and venous thrombotic events. Underlying malignancy may contribute to treatment resistance and worsen prognosis, emphasizing the need for early recognition and multidisciplinary management.
Ailliet et al. (Sat,) studied this question.