Case 294: Catastrophic Antiphospholipid Syndrome

Area of Science:

• Vascular Medicine
• Hematology
• Cardiology

Background:

• A 50-year-old woman with a history of fetal death presented with lower limb pain, asthenia, and arthralgia.
• Initial investigations revealed anemia, thrombocytopenia, elevated C-reactive protein, and high d-dimer levels.

Observation:

• Compression ultrasonography confirmed bilateral calf vein thrombosis.
• Following initiation of low-molecular-weight heparin for anticoagulation, the patient developed dyspnea, chest and abdominal pain, and fingertip necrosis.
• Laboratory tests showed acute kidney injury, proteinuria, and elevated troponin levels, indicating cardiac involvement.

Findings:

• The patient presented with deep vein thrombosis (DVT) complicated by potential pulmonary embolism and cardiac injury.
• Imaging studies, including contrast-enhanced CT and cardiac MRI, were performed to further evaluate the extent of the condition.

Implications:

• This case underscores the importance of vigilant monitoring for complications in patients with DVT, particularly those with risk factors.
• Prompt diagnosis and management of DVT and its sequelae are crucial for patient outcomes.