2.2 Catastrophic antiphospholipid syndrome
cAPS is characterized by microthromboses involving at least three organs within a week and is a rare but severe complication of APS. It affects about 1% of APS patients and the mortality rate reaches 36%. Agmon-Levin et al. demonstrated that hyperferritinemia can be found in patients with primary APS and that it correlates with cAPS (71% of cAPS had hyperferritinemia) (55). Similarly, in SLE patients, hyperferritinemia correlates with thrombocytopenia, the presence of lupus anticoagulant and of anti-cardiolipin antibodies, suggesting it could be an early marker for secondary APS (56). An emerging complication occurring in COVID-19 is coagulopathy and possible thrombotic microangiopathy (TMA) (57). A case of COVID-19 and antiphospholipid antibodies with multiple infarcts has been recently described. Interestingly, markedly elevated ferritin was found also in this patient, strikingly reinforcing the connection between infection, coagulopathy and hyperferritinemia (58).