{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:08:31Z","timestamp":1777928911742,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Catastrophic antiphospholipid syndrome (CAPS) is a rare and serious phenomenon that requires prompt recognition and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>The authors present the case of a puerperal woman with systemic lupus erythematosus (SLE) admitted to the emergency room with headache, blurred vision, thoracic pain, and purpuric lesions on both ears. Echocardiogram revealed global decrease in left ventricular function while cardiac and inflammatory markers were elevated. Three days after admission she developed cardiogenic shock due to rupture of mitral papillary muscle which required emergent cardiac surgery, with replacement of the mitral valve; treatment with anticoagulation, high-dose glucocorticoids, and intravenous immunoglobulins were initiated. Cardiac and brain MRI revealed signs of ischemic lesions in both organs. Histopathology analysis of the placenta and papillary muscle showed signs of ischemia secondary to microvascular thrombosis. Based on the clinical demonstration of thrombosis in three organs, and the presence of lupus anticoagulant antibodies, a diagnosis of probable CAPS was established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of a high level of suspicion of CAPS, particularly in patients with risk factors, and the value of immediate adequate treatment. Moreover, the rupture of a papillary muscle with histologically consistent signs of antiphospholipid syndrome expands the spectrum of involvement of this disease and should be considered as a rare but life-threatening possibility in patients with myocardial injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033211002273","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T21:27:06Z","timestamp":1616102826000},"page":"1017-1021","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Catastrophic antiphospholipid syndrome presented as ruptured papillary muscle during puerperium in a patient with systemic lupus erythematosus"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9901-1716","authenticated-orcid":false,"given":"In\u00eas Rueff","family":"Rato","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Rita","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Baixo Vouga, Aveiro, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Jo\u00e3o","family":"Afonso","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, Centro Hospitalar de Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Be\u00e7a","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2017.1300522"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1191\/0961203303lu394oa"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203320951260"},{"key":"e_1_3_2_5_2","first-page":"63","article-title":"Papillary muscle rupture as a manifestation of SLE in the puerperium","volume":"24","author":"Rijo D","year":"2017","unstructured":"Rijo D, Costa S, Monteiro J, et\u00a0al. Papillary muscle rupture as a manifestation of SLE in the puerperium. Rev Port Cir Cardiotorac Vasc 2017; 24: 63\u201365.","journal-title":"Rev Port Cir Cardiotorac Vasc"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/13.12.3202"},{"key":"e_1_3_2_7_2","article-title":"Vascular endothelial cell function in catastrophic antiphospholipid syndrome: a case report and review of the literature","volume":"2013","author":"Routy B","year":"2013","unstructured":"Routy B, Huynh T, Fraser R, S\u00e9guin C. Vascular endothelial cell function in catastrophic antiphospholipid syndrome: a case report and review of the literature. 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