{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:00:19Z","timestamp":1785218419815,"version":"3.55.0"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe cutaneous ulceration in antiphospholipid syndrome (APS) with concurrent infection and thrombocytopenia presents a therapeutic dilemma: standard immunosuppression risks worsening infection, while anticoagulation risks hemorrhage. We present a high-risk case successfully managed using intravenous immunoglobulin (IVIG) as a bridging immunomodulatory strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 73-year-old man with triple-positive APS and immune thrombocytopenic purpura (ITP) developed rapidly progressive leg ulcers with clinical features consistent with pyoderma gangrenosum-like disease, complicated by active MRSA and\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      infection and severe thrombocytopenia (12 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L). Standard therapies were contraindicated: corticosteroids risked worsening infection; anticoagulation risked hemorrhage. The patient received IVIG (0.4 g\/kg per dose, every 3 weeks) as primary immunomodulation, concurrent targeted antimicrobial therapy, temporary anticoagulation interruption, and discontinuation of baseline mycophenolate mofetil. Following platelet recovery above 70 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L, therapeutic anticoagulation was resumed with enoxaparin (80 mg subcutaneously twice daily) and aspirin (75 mg daily). Over five months, progressive re-epithelialization culminated in complete healing with platelet recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case supports the feasibility of IVIG as a bridging immunomodulatory strategy in high-risk APS cutaneous disease where standard therapies are contraindicated by concurrent infection and thrombocytopenia. The sequential management approach successfully resolved a clinically challenging scenario. This case illustrates how risk-adapted immunomodulation may enable safe management of complex APS manifestations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1867840","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:37:30Z","timestamp":1785217050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: IVIG as a bridging strategy in high-risk antiphospholipid syndrome with infected cutaneous ulceration and thrombocytopenia"],"prefix":"10.3389","volume":"17","author":[{"given":"Aliaa","family":"Khalili","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouraldeen","family":"Deeb","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salahaldeen","family":"Deeb","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fares Sayed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Younis Malik Younis","family":"Amro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Altell","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203321990100","article-title":"Cutaneous manifestations of antiphospholipid syndrome","volume":"30","author":"G\u00f3mez-Flores","year":"2021","journal-title":"Lupus"},{"key":"B2","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"Miyakis","year":"2006","journal-title":"J Thromb Haemostasis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-020-0452-y","article-title":"Pathogenesis of antiphospholipid syndrome: an update","volume":"16","author":"Meroni","year":"2020","journal-title":"Nat Rev 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antiphospholipid syndrome","volume":"132","author":"Giannakopoulos","year":"2013","journal-title":"Thromb Res"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1083083","article-title":"Neutrophil extracellular traps in systemic lupus erythematosus and antiphospholipid syndrome","volume":"14","author":"Conti","year":"2023","journal-title":"Front Immunol"}],"container-title":["Frontiers in 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