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A diagnosis of probable catastrophic APS was made and she improved dramatically with a combination of plasmapheresis, corticosteroids and therapeutic anticoagulation. Serological markers of APS were negative. Her hospital course was complicated by Libman Sacks endocarditis with significant aortic regurgitation that improved markedly with anticoagulation obviating the need for high-risk cardiac surgery. At discharge, she was stable and well and was advised long-term anticoagulation and rheumatology follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2018-224172","type":"journal-article","created":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T09:17:54Z","timestamp":1528103874000},"page":"bcr-2018-224172","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["An extraordinary case of recurrent stroke, disseminated thrombosis and endocarditis"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8253-2451","authenticated-orcid":false,"given":"Liza Mariam","family":"Thomas","sequence":"first","affiliation":[{"name":"Department of General Medicine, Rashid Hospital, Dubai, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niaz Ahmed","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Rashid Hospital, Dubai, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjana","family":"Pradeep","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Rashid Hospital, Dubai, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,6,4]]},"reference":[{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.287.6398.1021"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.2","first-page":"508","article-title":"The catastrophic antiphospholipid syndrome","volume":"19","author":"Asherson","year":"1992","journal-title":"J Rheumatol"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.01753.x"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.4","doi-asserted-by":"publisher","DOI":"10.1191\/0961203303lu394oa"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.5","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X13502919"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.6","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-009-0073-6"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.7","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.006163"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/389601","article-title":"The mosaic of \"seronegative\" antiphospholipid syndrome","volume":"2014","author":"Conti","year":"2014","journal-title":"J Immunol Res"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.9","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket126"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.10","first-page":"614","article-title":"Fall in antiphospholipid antibody at time of thromboocclusive episodes in systemic lupus erythematosus","volume":"16","author":"Drenkard","year":"1989","journal-title":"J Rheumatol"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.11","first-page":"541","article-title":"Antiphospholipid syndrome without antiphospholipid antibodies at the time of the thrombotic event: transient seronegative antiphospholipid syndrome?","volume":"15","author":"Miret","year":"1997","journal-title":"Clin Exp Rheumatol"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.12","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1082266"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.13","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jemermed.2014.06.031","article-title":"Seronegative catastrophic antiphospholipid syndrome in a young female presenting with a headache","volume":"48","author":"Losonczy","year":"2015","journal-title":"J Emerg Med"},{"key":"2025082722341410000_2018.jun01_1.bcr-2018-224172.14","doi-asserted-by":"crossref","unstructured":"Park H , et al . \"Outcome of Disseminated Intravascular Coagulation without Documented Antiphospholipid Antibody Successfully Treated with Rituximab.\". 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