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Lupus, Vol. 16, No. 1, 59-64 (2007)
DOI: 10.1177/0961203306073166

Reviews

Catastrophic antiphospholipid syndrome associated with malignancies (case report and review of the literature)

H Ideguchi

Chronic Intractable Disease Center, Yokohama City University Medical Center, Yokohama, Japan

S Ohno

Chronic Intractable Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan ohno{at}urahp.yokohama-cu.ac.jp

A Ueda

Y Ishigatsubo

Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

We describe a 58-year old female patient with rapid development of arterial and venous thromboembolisms, including deep vein thrombosis (DVT) in the lower limbs, recurrent cerebral infarctions and bilateral pulmonary emboli. Her laboratory data on admission showed positive anticardiolipin antibody of IgG isotype (IgG aCL) and positive anti-ß2 glycoprotein-I antibody of IgG isotype (IgG aß2-GPI), and decreased protein C activity and protein S antigen. Systemic examinations revealed the presence of an ovarian cancer. Surgical resection was attempted, but her cancer infiltrated the pelvic wall and could not be resected. Despite treatment with unfractionated heparin followed by warfarin, she died due to recurrent episodes of cerebral infarction.

This case was considered as probable catastrophic antiphospholipid syndrome (CAPS), which might be associated with ovarian cancer. Known as Trousseau's syndrome, arterial and, more commonly, venous thrombosis is a frequent complication of cancer and sometimes a harbinger of occult cancer. Our case indicates that there is an overlap between antiphospholipid syndrome (APS) and Trousseau's syndrome. It is important to bear in mind that a thrombotic event associated with cancer can be the first manifestation of CAPS.

Key Words: catastrophic antiphospholipid syndrome • malignancies • ovarian cancer • recurrent cerebral infarctions • Trousseau's syndrome


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