title: A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome.
abstract: We describe a previously healthy 28-year-old woman who presented with the clinical picture of large vessel occlusions (stroke with left hemiparesis, myocardial infarction) and developed multi-organ failure (i.e. kidneys, heart, brain, liver, blood, skin) over a very short period of time. Peripheral blood smear was consistent with thrombotic thrombocytopenic purpura. Transesophageal echocardiogram was supportive of the diagnosis of catastrophic antiphospholipid syndrome (CAPS), revealing Libman-Sacks endocarditis. Blood cultures were negative, anticardiolipin antibodies were highly increased and lupus anticoagulant was positive. Cerebral and coronary angiograms were negative, suggesting possible microthrombotic occlusive disease in the setting of CAPS.
authors.affiliation: Department of Critical Care and Pulmonary Services, University of Athens Medical School, 'Evangelismos' Hospital, Athens, Greece. ezakynth@yahoo.com
authors.forename: E G
authors.initials: EG
authors.lastname: Zakynthinos
authors.forename: T
authors.initials: T
authors.lastname: Vassilakopoulos
authors.forename: D D
authors.initials: DD
authors.lastname: Kontogianni
authors.forename: C
authors.initials: C
authors.lastname: Roussos
authors.forename: S G
authors.initials: SG
authors.lastname: Zakynthinos
mesh_terms: D000208:Acute Disease; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D009102:Multiple Organ Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013997:Time Factors