Brewster, Nathan, DO

Czysz, Aaron J, MD

Godil, Kareem, MD

Goldner, Breanna S, DO

Kears, Alaynna C, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Rash Provokes Catastrophic Antiphospholid Syndrome Alaynna C. Kears DO Lehigh Valley Health Network, Alaynna.Kears2@lvhn.org Nathan Brewster DO Lehigh Valley Health Network, Nathan.Brewster@lvhn.org Breanna S. Goldner DO Lehigh Valley Health Network, Breanna.Goldner@lvhn.org Kareem Godil MD Lehigh Valley Health Network, Kareem.Godil@lvhn.org Aaron J. Czysz MD Lehigh Valley Health Network, aaron_j.czysz@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Critical Care Commons, Internal Medicine Commons, and the Pulmonology Commons Published In/Presented At Kears, A. C., Brewster, N. Goldner, B. S., Godil, K. Czysz, A. (2019, October 19). Rash Provokes Catastrophic Antiphospholid Syndrome. Poster Presented at: CHEST, New Orleans, LA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2019 Lehigh Valley Health NetworkLVHN.orgRash Provokes Catastrophic Antiphospholid SyndromeAlaynna C. Kears, DO,1  Nathan Brewster, DO,1  Breanna S. Goldner, DO,1 Kareem Godil, MD,1 Aaron Czysz, MD21Department of Internal Medicine, Lehigh Valley Health Network, Allentown, Pa. 2Division of Pulmonary and Critical Care Medicine, Lehigh Valley Health Network, Allentown, Pa.Treatment•  Treated with methylprednisolone, plasma exchange, and a heparin infusion•  Overall condition began improving within 24 hours and he was eventually extubatedDiscussion•  CAPS is difficult to diagnose with a need for high  clinical suspicion especially in the setting of concomitant illnesses•  Clinical diagnosis became even more difficult as the patient had such significant physical exam findingsConclusion•  Importance of a high clinical suspicion to facilitate and receive prompt treatment in order to improve a patient’s chances of survival given the increased morbidity and mortality associated with CAPSReference1 1. Nayer A, Ortega LM. Catastrophic antiphospholipid syndrome: a clinical review. J Nephropathol. 2014;3(1):9-17.IntroductionCatastrophic Antiphospholipid Syndrome (CAPS)•  A rare life-threatening condition characterized by acute thrombosis in multiple organ systems•  Presence of positive antiphospholipid antibodies and organ failureCase DescriptionHistory of Present Illness•  55-year-old male with a history of psoriasis presents with a rash after receiving general anesthesia and cefazolin for an elective circumcision•  Painful diffuse erythematous and pustular rash covering his entire body•  Rash found to be due to Acute Generalized Exanthematous Pustulosis•  Two days later, lost vision in right eye and found to have acute branch retinal artery occlusion•  Became hypotensive, somnolent, and confused and found to have a dilated right pupilLabs and Imaging•  Developed acute renal failure with elevated troponins•  Autoimmune and vasculitis workup were unremarkable•  MRI Brain revealed left middle cerebral artery strokeProgression•  Started on pressors for shock and required intubation due to increased work of breathing•  Repeat MRI Brain revealed three new infarcts in the right frontal lobe and basal ganglia•  TEE was performed due to concern for endocarditis however it was negative for vegetation•  Bilateral lower extremity ultrasound was negative for deep venous thrombosis•  Thrombotic workup was remarkable for a positive lupus anticoagulant, hexagonal phase phospholipid, and dilute Russell’s viper venom time screenImage 2. Repeat MRI of the Brain which revealed two of the three new infarcts in the right frontal lobe and basal ganglia.Image 1. Initial MRI of the Brain which revealed left middle cerebral artery stroke.

Rash Provokes Catastrophic Antiphospholid Syndrome

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Rash Provokes Catastrophic Antiphospholid Syndrome

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