Catastrophic antiphospholipid antibody syndrome presenting with multiple thromboses and sites of avascular necrosis

We describe the case of a 25-year-old woman who presented with the antiphospholipid antibody syndrome (APS) manifesting as hemolytic anemia, thrombocytopenia, renal insufficiency, thromboses in multiple sites including skin, spleen and nasal mucosa, and multiple sites of avascular necrosis of bone. Interestingly, she also had low grade disseminated intravascular coagulation, which has been suggested to be a mechanism for avascular necrosis. We suggest that the APS may be one cause of thrombosis in avascular necrosis.