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Coronavirus disease 2019 and catastrophic antiphospholipid syndrome: Case report
Shanshan Jin1, Shiquan Wu1, Bin Cai2
1Physical Examination Department, Quzhou Central Blood Station, Quzhou, Zhejiang Province, China.
Insights
Catastrophic antiphospholipid syndrome (CAPS) is a severe condition that can occur with COVID-19, leading to multiple blood clots and organ damage. Early recognition and treatment are crucial, though outcomes can be poor, as illustrated by this rare case.
Area of Science:
- Internal Medicine
- Rheumatology
- Infectious Diseases
Background:
- Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition characterized by widespread thrombosis and multi-organ involvement.
- The co-occurrence of CAPS with coronavirus disease 2019 (COVID-19) presents diagnostic challenges due to diverse clinical manifestations and high mortality.
- Understanding the mechanism of CAPS in COVID-19 patients is critical for effective management.
Purpose of the Study:
- To report a rare case of CAPS in a patient with COVID-19.
- To highlight the diagnostic complexities and clinical presentation of co-occurring CAPS and COVID-19.
- To emphasize the importance of early recognition and treatment for improving patient outcomes.
Main Methods:
- A 64-year-old male patient with COVID-19 presented with progressive symptoms of multiple thrombi, organ dysfunction, and tissue necrosis.
- Diagnosis of CAPS was confirmed by positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing and high-titer immunoglobulin (Ig) A anti-β2-glycoprotein I antibody (anti-β2GPI).
- Treatment involved anticoagulants, plasmapheresis, glucocorticoid pulse therapy, antibiotics, and multi-organ support.
Main Results:
- The patient experienced extensive thrombosis, including pulmonary embolism, renal embolism, deep vein thrombosis, transient ischemic attack, and necrosis of limbs, ears, and genitalia.
- Aggressive treatment led to clinical symptom control but could not reverse tissue necrosis.
- The patient ultimately succumbed to necrotic tissue infection after refusing limb amputation.
Conclusions:
- CAPS associated with COVID-19 is a critical illness with a high mortality rate, necessitating prompt diagnosis and intervention.
- Physicians must maintain a high index of suspicion for CAPS in COVID-19 patients presenting with multiple thrombi.
- This case provides a basis for further research into the mechanisms of IgA anti-β2GPI-positive CAPS in COVID-19 and potential therapeutic strategies.
Rationale:
The emergence of catastrophic antiphospholipid syndrome (CAPS) alongside coronavirus disease 2019 (COVID-19) is of great concern, because of its high mortality and unclear mechanism. This severe disease, characterized by multiple thrombi and multisystem disorder, has notably diverse clinical presentations, which complicates its diagnosis in clinical practice. Now, we report a rare case of CAPS in a patient with COVID-19.
Patient Concerns:
A 64-year-old patient who mainly presented with pain and swelling 2 months ago progressed gradually into multiple thrombi, including pulmonary embolism, renal embolism, and deep vein thrombosis; transient ischemic attack; multiple organ dysfunction with acute kidney injury; and necrosis of both lower limbs, left upper extremity, both ears, and penile gangrene.
Diagnoses:
He was diagnosed as CAPS with COVID-19 by positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing and high-titer immunoglobulin (Ig) A anti-β2-glycoprotein I antibody (anti-β2GPI).
Interventions:
Active rescue treatments such as anticoagulants, plasmapheresis, glucocorticoid pulse therapy, antibiotics, and multi-organ functional support alleviated the disease effectively.
Outcomes:
Although his clinical symptoms were successfully controlled, we could not save the necrotic tissue. The patient refused to undergo limb amputation and died of necrotic tissue infection.
Lessons:
CAPS in patients with COVID-19 is an extremely serious disease with a high mortality rate. A delay in diagnosis and treatment can result in potentially devastating consequences. Therefore, physicians should be alert to the possibility of CAPS in patients with multiple thrombi and COVID-19. Furthermore, this case serves as a foundation upon which future studies can build to investigate the possible mechanisms of IgA anti-β2GPI-positive CAPS in patients with COVID-19, which may guide the exploration of potential therapeutic strategies to prevent the disease's progression.
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