Open AccessA Case Report of COVID-Associated Catastrophic Antiphospholipid Syndrome Successfully Treated with Eculizumab
Author(s) -
Anusha Chidharla,
Salman Syed,
Tulika Chatterjee,
Michael D. Tarantino
Publication year - 2021
Publication title -
journal of blood medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.676
H-Index - 18
ISSN - 1179-2736
DOI - 10.2147/jbm.s324873
Subject(s) - eculizumab , antiphospholipid syndrome , medicine , catastrophic antiphospholipid syndrome , immunology , thrombosis , complement system , antibody
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by multiple episodes of venous and arterial thromboses or recurrent fetal losses in the presence of antiphospholipid antibodies against β 2 GP1, frequently accompanied by moderate thrombocytopenia. Catastrophic APS (CAPS) is a severe manifestation of APS. COVID-19 may have an intense hypercoagulable state in critically ill patients. SARS-CoV2 may potentiate pathogenic APS effects, including the activation of endothelial cells, monocytes, platelets, and complement, resulting in a proinflammatory state and prothrombotic events. The endothelial tropism of SARS-CoV2 may also modify the clinical presentation of COVID-19 in susceptible individuals and trigger flares of underlying vascular diseases. We report a case of a 64-year-old woman with a history of triple-positive APS who had multiple thrombotic and bleeding episodes after being found to have a COVID-19 infection temporally associated with CAPS development that was successfully treated with eculizumab, preventing further macro- and microvascular thrombotic events at 1 month follow-up. Our case highlights the need for more research regarding the mechanism by which COVID-19 may potentiate APS and lead to the development of CAPS.