Viral Infections and Their Relationship with Catastrophic Antiphospholipid Syndrome: A Possible Pathogenic Mechanism of Severe COVID‐19 Thrombotic Complications

Mendoza‐Pinto, Claudia; Escárcega, Ricardo O.; García‐Carrasco, Mario; Bailey, David J.O.; Gálvez‐Romero, Jose Luis; Cervera, Ricard

The disease caused by SARS‐CoV‐2 (COVID‐19) has different presentations and outcomes. Severe COVID‐19 is commonly complicated by markedly elevated D‐dimer, thrombocytopenia and coagulation abnormalities that are considered to be regulated by various pro‐inflammatory cytokines and similar to pneumonia induced by other pathogens(1), and are correlated with mortality. Recently, a small case series described aPL antibodies in patients with COVID‐19 (2). About 1% of APS patients develop a severe life‐threatening clinical condition characterized by multiple thrombosis involving mainly small vessels, which has been described as catastrophic APS (CAPS). Patients with CAPS have in common: 1) clinical evidence of multiple organ involvement developing over a very short period of time; 2) histopathological findings of multiple small vessel occlusions, and 3) laboratory confirmation of the presence of aPL, usually in high titres.