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Catastrophic antiphospholipid syndrome — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesCatastrophic antiphospholipid syndromeSCE Rheumatology

A 31-year-old woman with triple-positive antiphospholipid antibodies develops encephalopathy, renal injury, thrombocytopenia, livedo and multiple infarcts over four days after infection. Which diagnosis best fits?

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Correct answer: C — Catastrophic antiphospholipid syndrome, with clinical reassessment

The best answer is “Catastrophic antiphospholipid syndrome, with clinical reassessment”. Rapid thromboses involving three or more organs in a patient with antiphospholipid antibodies strongly indicate catastrophic antiphospholipid syndrome and require urgent multidisciplinary treatment while mimics are assessed. The remaining choices—“Thrombotic thrombocytopenic purpura, after specialist assessment”, “Disseminated intravascular coagulation, within a rheumatology pathway”, “Libman–Sacks endocarditis, after safety review”, “Sneddon syndrome, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: EULAR antiphospholipid syndrome recommendations: https://pmc.ncbi.nlm.nih.gov/articles/PMC11034817/