title: Catastrophic antiphospholipid syndrome: remission following leg amputation in 2 cases.
abstract: OBJECTIVE
  The antiphospholipid syndrome is characterized by venous and arterial thrombotic events that are often recurrent, thrombocytopenia, recurrent fetal loss, and elevated titers of antiphospholipid antibodies. A subtype of patients with a particularly overwhelming clinical picture has been termed catastrophic antiphospholipid syndrome (CAPS). In this report, we present 2 patients who exhibited a similar multisystem disorder associated with gangrenous changes in the lower extremities.
  
  
  METHODS
  Two patients with CAPS are presented, highlighting the impact of this disorder on the patients and the response to various therapeutic modalities.
  
  
  RESULTS
  Both patients had pulmonary, cardiac, cutaneous, and neurologic findings consistent with CAPS. In addition, they had large purulent leg ulcers associated with livedo reticularis. Amputation of the legs in each case induced remission of the systemic illness.
  
  
  CONCLUSIONS
  We believe that infection plays a significant role in the pathogenesis and amplification of the antiphospholipid syndrome. In certain patients, this association probably is mediated via immune mechanisms, which also enhance the genesis of atherosclerosis. After the foci of infection (suppurative leg ulcers) were removed, the underlying illness improved. These case studies provide an opportunity to study the interrelationship between several confounding factors that converge and lead to the development of this autoimmune condition.
authors.affiliation: Department of Medicine, Center of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Amital
authors.forename: Y
authors.initials: Y
authors.lastname: Levy
authors.forename: C
authors.initials: C
authors.lastname: Davidson
authors.forename: I
authors.initials: I
authors.lastname: Lundberg
authors.forename: A
authors.initials: A
authors.lastname: Harju
authors.forename: Y
authors.initials: Y
authors.lastname: Kosach
authors.forename: R A
authors.initials: RA
authors.lastname: Asherson
authors.forename: Y
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000671:Amputation, Surgical; D016736:Antiphospholipid Syndrome / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D001161:Arteriosclerosis / Q000150:complications / Q000473:pathology; D002388:Catastrophic Illness; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000473:pathology; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction