Survival After Catastrophic Antiphospholipid Syndrome With Diffuse Alveolar Hemorrhage

Antiphospholipid syndrome is a systemic autoimmune disorder characterized by thrombotic events in the presence of antiphospholipid antibodies including lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein I antibodies. Catastrophic antiphospholipid syndrome is a rare but life-threatening variant, accounting for less than 1% of antiphospholipid syndrome cases, and is characterized by rapid progressive microvascular thrombosis and multiorgan failure. We report the case of a middle-aged man who developed catastrophic antiphospholipid syndrome associated with systemic lupus erythematosus, presenting with diffuse alveolar hemorrhage, acute kidney injury, vasculitis skin lesions, and severe thrombocytopenia. Management requires intensive care support, immunosuppressive therapy, intravenous immunoglobulin administration, cyclophosphamide administration, and delayed plasmapheresis. Despite multi-organ involvement and guarded prognosis, the patient survived following multidisciplinary management. This case highlights the importance of early recognition, rapid therapeutic intervention, and coordinated interdisciplinary care to improve survival in patients with catastrophic antiphospholipid syndrome.