Catastrophic antiphospholipid syndrome presenting with a stroke as a first presentation: case report

Catastrophic Antiphospholipid Syndrome (CAPS), an autoimmune disease that causes multi-organ thromboses leading to their failure, is a rapidly developing form of antiphospholipid syndrome (APS). APS may be a primary disease or secondary to an autoimmune condition like Systemic Lupus Erythematosus (SLE). A 31-year-old male patient with unremarkable medical history presented with a sudden onset of left-sided body weakness including upper and lower extremities, frontal headache, and slurred speech. Diagnostic workup revealed diffuse ST elevation with elevated cardiac enzymes, elevated inflammatory markers, prolonged activated partial thromboplastin time (aPTT), hemolytic anemia, and intrarenal kidney injury. Further investigations confirmed the diagnosis of probable CAPS secondary to SLE, based on the simultaneous involvement of the brain, heart, and kidneys, along with the presence of positive antiphospholipid antibodies (aPL). The patient showed significant improvement in neurological functioning after treatment with Methylprednisolone, Hydroxychloroquine, Colchicine, and Rituximab.