Author
- Ajitesh Roy
- Jyotirmay Maji
Abstract
Background :
Catastrophic antiphospholipid syndrome (CAPS), a rare thrombotic manifestation of antiphospholipid syndrome (APS), carries high mortality. Bilateral adrenal haemorrhage (BAH), an unusual complication of APS, is seldom reported. This case highlights a rare presentation of bilateral adrenal haemor- rhage due to probable CAPS secondary to systemic lupus erythematosus SLE).
Case Presentation :
A 57-year-old diabetic female from India, presented with hypovolemic shock, abdominal pain, and vomiting. Clinical evaluation, imaging(CECT abdomen), and laboratory investigations(anti-42GP1 IgG, lupus anticoagulant, anticardiolipin antibodies) were conducted.Secondary causes like sepsis, trauma, and coagulopathies were excluded. SLE workup included ANA and anti-dsDNA testing.
CECT revealed bilateral adrenal haemorrhage. Persistent positivity for antiphospholipid antibodies confirmed APS. Elevated ANA (1:100) and anti-dsDNA suggested underlying SLE, despite absent typical symptoms. Serum cortisol.
(9.2 ug/ dL) and ACTH (180 pg/mL) indicated evolving adrenal insufficiency. The patient received methylprednisolone pulses, IVIG, anticoagulants, and immunosuppres-sants (MMF), achieving rapid stabilisation without mineralocorticoid replace- ment.
Conclusion :
This case underscores Bilateral Adrenal haemorrhage as a rare and atypical manifestation of CAPS and any case of APS should always be evaluated for background SLE. Early diagnosis via antibody testing and imaging, combined with aggressive immunosuppression and anticoagulation, improves outcomes.This report enriches the limited literature on CAPS-related BAH multidisciplinary management in thrombotic-autoimmune syndromes.
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