Journal of Blood Medicine (Oct 2021)
A Case Report of COVID-Associated Catastrophic Antiphospholipid Syndrome Successfully Treated with Eculizumab
Abstract
Anusha Chidharla,1 Salman B Syed,2 Tulika Chatterjee,2 Michael D Tarantino3 1Department of Medical Oncology, Kansas University Cancer Center, Kansas, KS, USA; 2Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA; 3Department of Hematology, Bleeding and Clotting Disorders Institute, Peoria, IL, USACorrespondence: Anusha Chidharla 9219 West 157th Terrace, Overland Park, KS, 66221, USATel +1 913-568-5708Email [email protected]: 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 β2GP1, 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.Keywords: antiphospholipid syndrome, phospholipid autoantibodies, catastrophic APS, COVID-19, severe acute respiratory syndrome coronavirus 2, eculizumab
