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The catastrophic antiphospholipid (Asherson's) syndrome.

Ronald A Asherson1

  • 1Division of Immunology, School of Pathology, University of the Witwatersrand, PO Box 1038, Johannesburg, South Africa. ashron@icon.co.za

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Catastrophic antiphospholipid syndrome (CAPS) is a rapid, severe condition in antiphospholipid antibody-positive patients, often triggered by infections or trauma. Early, aggressive treatment improves survival rates for this rare but dangerous thrombotic disorder.

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Area of Science:

  • Rheumatology
  • Hematology
  • Critical Care Medicine

Background:

  • Catastrophic antiphospholipid syndrome (CAPS), also known as Asherson's syndrome, is a rare, life-threatening condition.
  • It is characterized by rapid, widespread thrombosis in small and large vessels.
  • CAPS typically occurs in patients with primary antiphospholipid syndrome or systemic lupus erythematosus (SLE).

Purpose of the Study:

  • To summarize the key features of CAPS.
  • To highlight the triggering factors and clinical manifestations of CAPS.
  • To discuss the current therapeutic approaches and their impact on mortality.

Main Methods:

  • Review of existing literature on CAPS.
  • Analysis of clinical presentation, triggers, and outcomes.
  • Evaluation of treatment strategies including anticoagulation, corticosteroids, and immunomodulatory therapies.

Main Results:

  • CAPS develops rapidly after identifiable triggers like infection, trauma, or obstetric events.
  • Manifestations include small vessel thromboses in organs (gastrointestinal, cerebral, cardiac) and large vessel occlusions.
  • Systemic inflammatory response syndrome (SIRS), including acute respiratory distress syndrome (ARDS), is common.

Conclusions:

  • Despite high mortality, early and effective multi-modal therapy has shown recent improvements in survival.
  • Aggressive anticoagulation, corticosteroids, plasma exchange, and IV globulins are crucial.
  • Prompt diagnosis and management are essential for improving outcomes in CAPS patients.