Catastrophic antiphospholipid syndrome in a patient with immune thrombocytopenic purpura

A 47-year old Caucasian male with 7-year history of Immune Thrombocytopenic Purpura (ITP) presented with acute onset pain and purplish-blue discoloration of the left fifth toe and pleuritic chest pain. At the time of ITP diagnosis, he was positive for lupus anticoagulant (LA) and high titer of IgG anticardiolipin antibodies (aCL). However, his platelet count had previously remained stable at approximately 40,000/μL and he never required treatment. His examination was normal except for dusky cyanosis and coolness of the left fifth toe associated with extreme tenderness. Abnormal laboratory studies on admission included leukocytosis (11.610/μL), thrombocytopenia (76,000 /μL) and elevated D-dimer (770 ng/mL FEU). Cardiac enzymes, EKG and Chest X-ray were normal. A lower extremity arterial study done prior to admission was normal.