Catastrophic antiphospholipid syndrome (CAPS) is an exceedingly rare (< 1 % of APS cases) but life-threatening variant of antiphospholipid syndrome, marked by rapid, widespread thrombosis that can precipitate myocardial infarction, stroke, and multiorgan failure. We report a 72-year-old south Asian woman with established cardiovascular risk factors—rest angina, hypertension, type 2 diabetes, hyperlipidaemia, and arthritis—who presented with acute right lower-limb ischemia manifesting as pain, pallor, and coolness. CT angiography revealed complete occlusion from the distal right common femoral artery into the crural vessels and severe stenosis of the left tibial and peroneal arteries. Despite emergent thrombectomy, thrombolysis, full anticoagulation, high-dose corticosteroids, and intravenous immunoglobulin (IVIG), clinical deterioration ensued, culminating in fatal multiorgan thrombosis. This case underscores the aggressive and often refractory nature of CAPS, where even prompt triple-therapy intervention may prove insufficient. Clinicians must balance the urgent need for anticoagulation against haemorrhagic risk, particularly in advanced ischemia or infarction. Mortality in CAPS was historically around 50%, though recent series report reductions to ~30–35% with early multimodal therapy Heightened awareness and rapid institution of anticoagulation combined with immunosuppression and vascular intervention remain critical to alter the otherwise dismal prognosis.
Topalkatti et al. (Fri,) studied this question.