A 60-year-old woman with no past medical history presented to the emergency department complaining of dyspnea, chest pain, edema in the left lower limb and right hemiparesis.
Brain CT showed an infarction of the left middle cerebral artery and CT scan of the thoracic-abdominal and lower limbs showed pulmonary thromboembolism, bilateral splenic and renal infarctions, and superficial bilateral pleural effusion, asc.
No images suggestive of neoplasia were detected.
Hematological analysis for the diagnosis of thrombophilia revealed the presence of lupus anticoagulant (LA) and anti-B2-glycoprotein antibodies, presence of factor V Leyden, (heterozygous methyltransferase) and hypermuhydrogenase (m
Tumor markers showed CEA: 2793 ng/ml, CA 12.5: 2070 IU/ml, CA 19.9: 1183 IU/ml, CA 15.3: 48 IU/ml.
Antinuclear antibodies and bilirubin, transaminase, lipase and amylase were negative.
The patient was diagnosed with catastrophic antiphospholipid syndrome and treated with prednisone 1 mg/kg/day and heparin not administered intravenously.
After clinical recovery, the patient was monitored every 3 months analytically and radiologically in outpatient clinics.
Nine months later, she developed thrombosis of the vena cava and pulmonary and hepatic metastases and died due to multisystem failure a few days later.
At autopsy, it was observed the presence of pancreatic tail adenocarcinoma, multiple metastases, arterial and venous thrombosis.
The anatomopathological study confirmed the presence of small and medium vessel thrombosis in lungs, kidneys, spleen and brain.
