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Background Catastrophic antiphospholipid syndrome (CAPS) is a rare condition associated with high mortality1. Prompt recognition and treatment is important for optimal outcomes. Clinical features of CAPS can overlap with obstetric complications, leading to diagnostic challenge2. Objectives Describe two patients with CAPS during immediate post-partum period. Methods We report two cases in a single centre over two years. Results A 38 year old with obstetric Antiphospholipid syndrome (APS) presented with epigastric pain, transaminitis and thrombocytopenia in keeping with evolving HELLP syndrome. Spontaneous complete miscarriage ensued. Post-delivery, she developed worsening abdominal pain and transaminitis (Table 1). Imaging demonstrated hepatic infarcts and patchy ground glass lung opacities. She was treated for CAPS with intravenous steroids and anticoagulation, and recovered. A 39 year old with primary APS (deep venous thrombosis and obstetric features) whose antenatal course was fraught with minor per vaginal bleeding (PVB) presented with heavy PVB at 22 weeks gestation requiring cessation of anticoagulation. She developed a deep venous thrombosis. Risk of clot propagation versus bleeding prompted cautious anticoagulation. Labour was induced for declining maternal health and poor foetal prognosis at 24 weeks, 3 days. Post-delivery, she developed abdominal pain, headache, transaminitis and worsening thrombocytopenia with heavy PVB requiring uterine artery embolization. Given features that were consistent with micro thrombi and ischaemia (Table 1), she was treated as for CAPS and HELLP syndrome with intravenous steroids, plasma exchange (PLEX) and intravenous immunoglobulin (IVIG), and recovered. ^Low molecular weight heparin. °Aspartate aminotransferase. «Alanine aminotransferase. ◊Lactate dehydrogenase. *Intravenous Methylprednisolone Conclusion Recognition of CAPS is complex in pregnancy. Vigilance is required for urgent aggressive treatment to improve outcomes in this uncommon condition. References [1] Bucciarelli S, Espinosa G, Cervera R, et al. Mortality in catastrophic antiphospholipid syndrome: causes of death and prognostic factors in a series of 250 patients. Arthritis Rheum 2006; 54: 2568–2576. [2] Silver RM. Catastrophic antiphospholipid syndrome and pregnancy. Semin Perinatol. 2018 Feb;42(1):26-32. Disclosure of Interests Nur Azizah Allameen: None declared, Aisha Lateef : None declared, Anita Yee Nah Lim Speakers bureau: I have been a speaker for Novartis last year |
