Catastrophic antiphospholipid antibody syndrome

Pediatric catastrophic antiphospholipid syndrome with extensive skin involvement

Antiphospholipid syndrome (APS) is a state of hypercoagulability due to persistent antiphospholipid antibodies (aPLs) in the blood. Catastrophic APS (CAPS) is a severe form with higher morbidity and mortality in which there occurs widespread thrombosis in multiple organs and hence warrants early diagnosis and aggressive management. We report a case of pediatric CAPS with extensive cutaneous involvement precipitated by infection successfully treated with the combination of high dose systemic corticosteroids, antibiotics, long-term anticoagulation, and wound care.

Catastrophic antiphospholipid antibody syndrome in a child with thrombotic microangiopathy

Thrombotic microangiopathic hemolytic anemia (TMHA) is not uncommon in clinical nephrology practice while antiphospholipid syndrome (APS) is uncommon. Although less than 1% of patients with APS develop catastrophic APS (CAPS), its potential lethal outcome because of thrombosis in multiple organs and subsequent multiorgan failure emphasizes its importance in nephrology practice. Here is a case of catastrophic APS in a 7-year-old girl, who presented to us with TMHA associated with antiphospholipid antibodies and subsequently died because of CAPS.

Renal involvement in the antiphospholipid syndrome (APS)-APS nephropathy

Although the kidney represents a major target organ in antiphospholipid syndrome (APS), renal involvement in APS was poorly recognized until recently. The most well-recognized renal manifestations of APS are the renal artery thrombosis/stenosis, renal infarction, hypertension, renal vein thrombosis, end-stage renal disease, increased allograft vascular thrombosis, some types of glomerular disease, and a small-vessel vaso-occlusive nephropathy, recently defined as APS nephropathy. APS nephropathy was first described in primary APS patients, characterized by acute thrombotic lesions in glomeruli and/or arterioles (thrombotic microangiopathy) and chronic vascular lesions such as fibrous intimal hyperplasia of arterioles and interlobular arteries, organized thrombi with or without recanalization, and fibrous arterial and arteriolar occlusions or focal cortical atrophy. APS nephropathy was also detected in further studies including patients with systemic lupus erythematosus (SLE)-related APS and SLE/non-APS patients with positive antiphospholipid antibodies, independently of lupus nephritis. The same histologic lesions, especially thrombotic mictroangiopathy, were also observed in patients with catastrophic APS. The most frequent clinical and laboratory characteristics of APS nephropathy in all the above groups of patients are hypertension (often severe), proteinuria (ranging from mild to nephrotic range), hematuria, and acute or chronic renal insufficiency.

Anesthetic implications of the catastrophic antiphospholipid syndrome

The antiphospholipid antibody syndrome (or the anticardiolipin antibody syndrome) is characterized by the presence of autoantibodies. Its major association is with systemic lupus erythematosus. 'Catastrophic' antiphospholipid syndrome (CAPS) is defined as an accelerated form of APS usually resulting in multiorgan failure and can be precipitated by surgery. We present the case of a 12-year-old male child who presented for enucleation of his left eye for fungal endopthalmitis. This patient had a history of CAPS 2 months before surgery with myocardial, gastrointestinal, renal and laryngeal involvement that improved on aggressive treatment and was subsequently managed on an outpatient basis for 2 months before presenting for enucleation. To the best of our knowledge, this is the first case of CAPS in a child reported in the anesthetic literature. Further aspects of this puzzling condition and its anesthesia implications are discussed.

Catastrophic antiphospholipid syndrome in a 7-year-old girl

Antiphospholipid syndrome (APS) has been recognized as the leading cause of vascular thrombosis in children. The syndrome may occur in isolation or in association with an underlying systemic disease, particularly systemic lupus erythematosus. Less than 1% of patients with APS present with a life-threatening condition resulting from thrombosis in multiple organs and subsequent multiorgan failure, which is defined as catastrophic APS. Early recognition of APS is essential because prompt and appropriate management can result in favorable outcome. We present the case of a 7-year-old girl with APS who presented with cerebral, femoral, and renal involvement in the second week of the disease progress. The patient presented with multiple thrombotic episodes and rapidly progressive renal failure. Renal cortical infarction was diagnosed by magnetic resonance imaging.