Corticosteroids, Plasmapheresis, Argatroban, Rituximab, and Sirolimus Provided Clinical Benefit for Catastrophic Antiphospholipid Syndrome in a Patient with a History of Heparin-Induced Thrombocytopenia

Table 1

Timeline of major treatments.

Day	Event
−23	First presentation and admission for APS
−17	Rituximab dose #1 of 3
−16	Discharged
−3	Second presentation and admission for CAPS
0	TPE #1 of 4
1	TPE #2 of 4
2	TPE #3 of 4
5	TPE #4 of 4
6	Rituximab dose #2 of 3; discharged
13	Rituximab dose #3 of 3
19	Patient diagnosed with avascular necrosis (AVN)
21	Due for a fourth dose of rituximab; this dose was not given. The three prior doses amounted to a total of 900 mg of rituximab administered, and the patient’s physicians decided that additional rituximab was unlikely to make a difference.
34	Sirolimus (2 mg daily) was started. Patient was on sirolimus for about 6 months.