Abstract
RATIONALE: The emergence of catastrophic antiphospholipid syndrome (CAPS) alongside coronavirus disease 2019 (COVID-19) is of great concern, because of its high mortality and unclear mechanism. This severe disease, characterized by multiple thrombi and multisystem disorder, has notably diverse clinical presentations, which complicates its diagnosis in clinical practice. Now, we report a rare case of CAPS in a patient with COVID-19. PATIENT CONCERNS: A 64-year-old patient who mainly presented with pain and swelling 2 months ago progressed gradually into multiple thrombi, including pulmonary embolism, renal embolism, and deep vein thrombosis; transient ischemic attack; multiple organ dysfunction with acute kidney injury; and necrosis of both lower limbs, left upper extremity, both ears, and penile gangrene. DIAGNOSES: He was diagnosed as CAPS with COVID-19 by positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing and high-titer immunoglobulin (Ig) A anti-β2-glycoprotein I antibody (anti-β2GPI). INTERVENTIONS: Active rescue treatments such as anticoagulants, plasmapheresis, glucocorticoid pulse therapy, antibiotics, and multi-organ functional support alleviated the disease effectively. OUTCOMES: Although his clinical symptoms were successfully controlled, we could not save the necrotic tissue. The patient refused to undergo limb amputation and died of necrotic tissue infection. LESSONS: CAPS in patients with COVID-19 is an extremely serious disease with a high mortality rate. A delay in diagnosis and treatment can result in potentially devastating consequences. Therefore, physicians should be alert to the possibility of CAPS in patients with multiple thrombi and COVID-19. Furthermore, this case serves as a foundation upon which future studies can build to investigate the possible mechanisms of IgA anti-β2GPI-positive CAPS in patients with COVID-19, which may guide the exploration of potential therapeutic strategies to prevent the disease's progression.