Catastrophic antiphospholipid syndrome in the second trimester of pregnancy

rial or venous thrombosis, recurrent fetal loss, moderate thrombocytopenia, and the presence of antiphospholipid antibodies. Classification criteria for catastrophic APS were recently defined, as follows: evidence of involvement of three or more organs, systems, and/or tissues; development of manifestations simultaneously or in less than a week with histopathologic evidence of vascular occlusion; and laboratory confirmation of the presence of antiphospholipid antibodies [1]. Catastrophic APS may also appear in pregnant women, presenting with thrombotic events including liver infarcts and fetal loss, as well as thrombocytopenia. This condition is often labeled as “HELLP-like syndrome.” HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) is a thrombotic microangiopathic vasculopathy presenting in pregnancy, which has some features similar to catastrophic APS. We present a 37 year old woman with catastrophic APS who developed multiple hepatic infarcts, thrombocytopenia and fetal death in her second trimester of pregnancy, and discuss whether her course represented a “HELLPlike syndrome” or a distinct clinical entity.