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Case Reports in Medicine
Volume 2013 (2013), Article ID 915309, 6 pages
http://dx.doi.org/10.1155/2013/915309
Case Report

Catastrophic Antiphospholipid Syndrome with Severe Acute Thrombotic Microangiopathy and Hemorrhagic Complications

1Department of Medicine, University of Miami, FL 33136, USA
2Division of Hematology, University of Miami, FL 33136, USA
3Department of Pathology, University of Miami, FL 33136, USA
4Division of Rheumatology, University of Miami, FL 33136, USA
5Division of Nephrology and Hypertension, University of Miami, Clinical Research Building, Suite 825, 1120 NW 14th Street, Miami, FL 33136, USA

Received 23 August 2013; Revised 19 October 2013; Accepted 13 November 2013

Academic Editor: Abhay R. Satoskar

Copyright © 2013 Gerardo B. Vieregge et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The catastrophic antiphospholipid syndrome (CAPS) is a rare life-threatening form of the antiphospholipid syndrome characterized by disseminated vascular thrombosis resulting in multiorgan failure. On an exceedingly rare occasion, CAPS can be associated with severe hemorrhagic manifestations. We report a young woman with a history of several spontaneous miscarriages who presented with menorrhagia and hemoptysis. The patient developed respiratory failure due to diffuse alveolar hemorrhage. Laboratory tests demonstrated severe hemolytic anemia, profound thrombocytopenia, markedly elevated fibrin degradation products, and renal failure. Blood films revealed numerous schistocytes. Serologic tests disclosed hypocomplementemia and autoantibodies directed against several nuclear antigens. Coagulation studies revealed lupus anticoagulant. Echocardiography demonstrated reduced ejection fraction and moderate to severe mitral and tricuspid regurgitation. The patient was diagnosed with CAPS with hemorrhagic manifestations in the setting of new-onset SLE. The patient was treated with hemodialysis, high-dose glucocorticoids, plasma exchange, intravenous cyclophosphamide, and rituximab. Over the ensuing four weeks, the combination therapy led to hematological, cardiopulmonary, and renal recovery. This exceedingly rare case emphasizes that hemorrhagic manifestations, severe microangiopathic hemolytic anemia, and profound thrombocytopenia can dominate the clinical picture in CAPS.