A Near Catastrophe: Antiphospholipid Syndrome and Catastrophic Antiphospholipid Syndrome Complicating Emergency Department Care

Abstract

Background

Antiphospholipid syndrome (APS) is an autoimmune syndrome that often clinically manifests as venous thrombosis, arterial thrombosis, pregnancy morbidity, and thrombocytopenia. While APS is rare and difficult to diagnose, it can lead to devastating complications, most notably catastrophic antiphospholipid syndrome (CAPS). Both APS and CAPS have a strong association with pregnancy, which is often what reveals a new diagnosis of APS. Recurrent spontaneous abortions and pre-eclampsia are the most common pregnancy-related triggers for APS, while Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP) syndrome is less common but more dangerous to the patient’s health.

Case Report

This case report identifies a 23-year-old female who presented to the emergency department (ED) 1-week postpartum with significant abdominal pain and nausea with vomiting. The report details an uncommon and life-threatening postpartum condition that was a result of a yet to be diagnosed autoimmune condition.

Why Should an Emergency Physician Be Aware of This?

APS is potentially life threatening, particularly when the patient’s clinical course is complicated by CAPS, but it is difficult to diagnose. This case report reveals 4 clinical clues found in the ED that pointed toward a new diagnosis of APS and impending CAPS. If a new diagnosis of APS is suspected or a patient with known APS is possibly presenting with CAPS, the emergency physician must be able to consider these diagnoses and appropriately begin therapeutic interventions. If possible, these interventions should be done in close consultation with the admitting team, particularly the intensive care unit and hematology.