Article Text

Unexpected outcome (positive or negative) including adverse drug reactions
Catastrophic cerebral antiphospholipid syndrome presenting as cerebral infarction with haemorrhagic transformation after sudden withdrawal of warfarin in a patient with primary antiphospholipid syndrome
  1. Abdul Majid Wani1,
  2. Waleed Mohd Hussain2,
  3. Mousa Ali Al Mejally3,
  4. Khaled Shawkat Ali4,
  5. Sadeya Hanif Raja2,
  6. Wael Al Maimani5,
  7. Mazen G Bafaraj4,
  8. Ashraf Bashraheel4,
  9. Mubeena Akhtar2,
  10. Amer Mohd Khoujah6
  1. 1
    Hera General Hospital, Medicine, 4a/201, Makkah, Western, 21955, Saudi Arabia
  2. 2
    Hera General Hospital, Medicine, Makkah, Western, 21955, Saudi Arabia
  3. 3
    Hera General Hospital, Medicine, Makka-KSA, Makkah, PO Box 20993, Saudi Arabia
  4. 4
    Hera General Hospital, Makkah, 21955, Saudi Arabia
  5. 5
    Umm Al-Qura University, Makkah, 21955, Saudi Arabia
  6. 6
    National Guard Hospital, Medicine, Jeddha, Western, 21955, Saudi Arabia
  1. Abdul Majid Wani, dr_wani_majid{at}


Catastrophic antiphospholipid syndrome (APS) is caused by thrombotic vascular occlusions that affect both small and large vessels, producing ischaemia in the affected organs. The “catastrophic” variant of the antiphospholipid syndrome (cAPS) develops over a short period of time. Although patients with cAPS represent <1% of all patients with APS, they are usually life threatening with a 50% mortality rate. A strong association with concomitant infection is thought to act as the main trigger of microthromboses in cAPS. Several theories have been proposed to explain these physiopathological features. Some of them suggest the possibility of molecular mimicry between components of infectious microorganisms and natural anticoagulants, which might be involved in the production of cross-reacting antiphospholipid antibodies. We present a case of catastrophic cerebral APS characterised by massive temporal lobe infarction and subsequent haemorrhagic transformation after sudden withdrawal of warfarin.

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  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.