Case 82 – Update 3

Thanks for your continued contributions for this tricky case! We’ve got some new investigations results from what you have requested:

Peak anti-Xa levels on re-admission: 0.84. INR 2.2.

No evidence of malignancy on recent CTPA / CT abdo pelvis.

HIT pre-test probability score: low risk therefore no further HIT investigations performed.

PNH: negative. JAK 2 negative.

Lupus anticoagulant final ratio: 2.1 (<1.2 normal)

IgG and IgM cardiolipin antibodies: <10 U/ml.

Anti IgG B2 glycoprotein antibodies 347 U/ml (0-7).

Our patient remains very unwell due to his progressive PEs (but haemodynamically stable), acute kidney injury, liver dysfunction (likely due to microvascular thrombi), and rash.

What is the likely diagnosis and how would you manage this patient?

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