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Sir,  Guleria et al. present a 42-year-old woman who developed systemic inflammatory response syndrome postoperatively and was eventually diagnosed as catastrophic antiphospolipid syndrome.[1]  In their discussion, the authors state that the patient had evidence of cardiovascular, hepatic and renal involvement and antiphospholipid antibodies were positive. In addition, the authors wrote that they could not demonstrate vessel thrombosis, but there was evidence of vasculitis.  We would like point to our previously published case report on acute respiratory failure associated with catastrophic antiphospholipid syndrome.[2]  Guleria et al. correctly classification criteria for catastrophic antiphospholipid syndrome.[3] However, there should be a significant evidence of thrombosis and/or microthrombosis, although vasculitis may coexist occasionally.  Therefore, we ask where is the evidence for thrombosis and/or microthrombosis in this case?

All that seems sepsis is not sepsis: However, is this case report really a case of catastrophic antiphospholipid syndrome?