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Ayrton Bangolo, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USAFollow
Sowmya Sagireddy, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Sarah Mahamadeen, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Felicia Hasta, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Sadhu A. Reddy, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Afshan Naz, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Ravishankar Ranganatha, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Cleveland Ricketts, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Padmavathi Muppalla, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Swathi Veliginti, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Georgemar Arana, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Dily T. Sathyarajan, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Sachin Singhal, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Tanvi Shetty, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Kshitij Bhardwaj, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Sayed Hashemy, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Roberto L. Duran, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Sung H. Kim, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Candice M. Hipolito, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Kibo Yoon, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Vrusha Patel, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Aseel Alshimari, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Pugazhendi Inban, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Saaniya Yasmeen, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA
Simcha Weissman, Department of Internal Medicine. Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ, USA

Abstract

A small subset of patients with antiphospholipid syndrome (APS) may develop widespread thrombotic disease with organ damage, referred to as catastrophic APS (CAPS) that is associated with a high mortality. Medical therapy typically involves a combination of anticoagulation, systemic glucocorticoids, plasmapheresis, and intravenous immune globulin (IVIG). There is currently no consensus for the management of refractory cases of CAPS. However, monoclonal antibodies such as rituximab and eculizumab have shown some benefits. Herein, we present a 29-year-old female with previous pulmonary embolism who presented with necrotic left toes and was eventually diagnosed with refractory CAPS, successfully treated with Plasmapheresis and Rituximab. With this case report, we hope to encourage the usage of Rituximab in the management of CAPS

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