To the Editor:
The catastrophic antiphospholipid syndrome (CAPS) is a rare and severe manifestation of the antiphospholipid syndrome (APS)1. We describe a case with features of both CAPS and polyarteritis nodosa (PAN), described only once previously in the literature.
A healthy 66-year-old man presented to an outside institution with progressive bilateral myalgias in his arms and lower legs. He reported fatigue and a 10-lb unintentional weight loss over the preceding month, but denied other symptoms or exposures. Blood pressure was 140/91 mm Hg, elevated from 120/70 mm Hg recorded 3 weeks earlier. He had cool, pale feet with diminished sensation and limited range of motion. Popliteal pulses were palpable, but dorsalis pedis and posterior tibial pulses were not detectable by Doppler ultrasound. The remainder of the examination was normal.
Hemoglobin was 109 g/l with mean corpuscular volume 87 fl, white blood cell count 31.6 × 109/l, (neutrophils 29 × 109/l), and platelets 967 × 109/l. Albumin was 29 g/l and creatinine 71 mmol/l. Coagulation measures were normal. Lupus anticoagulant was positive. Testing was done by an activated partial thromboplastin time assay, mixing studies, and a dilute Russell venom viper test, and confirmatory testing was performed. Aspartate aminotransferase was 107 U/l, alanine aminotransferase (ALT) 142 U/l, gamma-glutamyl transferase 52 U/l, and alkaline phosphatase 152 U/l. Creatine kinase was 1317 U/l and …
Address correspondence to Dr. Khalidi; E-mail: naderkhalidi{at}sympatico.ca