Pathological Study of a Case of Catastrophic Antiphospholipid Syndrome in a Patient With Gastrointestinal Bleeding

Catastrophic antiphospholipid syndrome (CAPS) is a very rare, life-threatening form of antiphospholipid syndrome (APS) characterized by multiorgan vascular occlusive events that occur rapidly in succession or simultaneously. Here, we describe a rare case of CAPS in a 67-year-old woman with a 26-year history of APS managed on therapeutic doses of warfarin presenting to hospital with a four-day history of melena secondary to gastrointestinal bleed. She was treated endoscopically, provided vitamin K for warfarin reversal, and started on dalteparin daily. During her course in hospital, she developed dyspnea and hypoxia with bilateral pleural effusions. The patient concurrently became increasingly hemodynamically unstable. She was treated with furosemide and broad-spectrum antibiotics but deteriorated, experienced cardiac arrest, and could not be successfully resuscitated. On autopsy, widespread microthrombi in cardiac, pulmonary, and cerebral tissues were identified and a diagnosis of CAPS was made. This case highlights the difficulty and importance of recognizing clinical manifestations of CAPS and balancing the risk for thrombosis when patients are undergoing treatment for concurrent serious health issues.