Back from the Brink: Catastrophic Antiphospholipid Syndrome

Cardiogenic shock was the first sign of a devastating disorder in a 27-year-old woman with multiple medical problems. She presented to an outside hospital after 2 days of nausea, epigastric pain, and worsening dyspnea on exertion. Her medical history included systemic lupus erythematosus, autoimmune hepatitis, immune thrombocytopenia, autoimmune hemolytic anemia, attention deficit hyperactivity disorder, anxiety, and migraines. The hemodynamic support provided might be inadequate for more severe cases of cardiogenic shock. In addition, the Impella does not directly improve pulmonary gas exchange, which may be severely impaired in the setting of acute pulmonary edema. Here, Gupta et al present their assessment, diagnosis and management of the woman with catastrophic antiphospholipid syndrome.