Unmasking Antiphospholipid Syndrome: Massive Pulmonary Embolism and Extensive Venous Thrombosis in a Young Male
Recommended Citation
Naveed AK, Alali M, Al-Antary N, Rajput AS, Alsharif A, El-Haddad H. Unmasking Antiphospholipid Syndrome: Massive Pulmonary Embolism and Extensive Venous Thrombosis in a Young Male. Am J Respir Crit Care Med 2026; 212:2.
Document Type
Conference Proceeding
Publication Date
5-15-2026
Publication Title
Am J Respir Crit Care Med
Keywords
General & Internal Medicine, Respiratory System
Abstract
Background Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder characterized by recurrent arterial and venous thromboses in the presence of antiphospholipid antibodies. Although more common in middle-aged females, it can rarely present in young males with catastrophic thrombotic events. We present a case of a previously healthy 21-year-old male who developed massive pulmonary embolism (PE) and extensive deep venous thrombosis (DVT) as the first manifestation of probable APS. Case A 21-year-old male with no prior medical history presented with three weeks of progressive shortness of breath and hemoptysis. He denied recent travel, surgery, immobilization, infection, or family history of thrombosis. On arrival, he was tachycardic to 120 bpm, hemodynamically stable, and oxygenating well on room air. Laboratory testing revealed leukocytosis and elevated D-dimer. Imaging demonstrated near-occlusive emboli in the main pulmonary artery extending into bilateral branches with pulmonary infarctions and marked right ventricular (RV) strain. CT abdomen and pelvis showed extensive thrombus involving the right common iliac, external iliac, and femoral veins. Transthoracic echocardiogram revealed severely reduced RV systolic function with a small pericardial effusion. Given the extensive thrombus burden and RV dysfunction, the patient was transferred to a higher level of care for advanced intervention. Mechanical thrombectomy successfully cleared the clot from the inferior vena cava, right iliac, femoral, and popliteal veins. Post-procedure echocardiogram demonstrated improved RV function and reduced pulmonary artery pressures. Hypercoagulable workup revealed a positive lupus anticoagulant (PTT-LA 47.9 sec, positive hexagonal phospholipid confirmation, RVV ratio 1.2) with negative β2-glycoprotein and anticardiolipin antibodies, consistent with probable APS pending confirmatory testing at 12 weeks. He was transitioned to warfarin and discharged hemodynamically stable with hematology follow-up. Discussion: This case highlights that a young male presenting with unprovoked, massive PE and extensive DVT should prompt evaluation for APS. Pulmonary embolism is the most frequent pulmonary manifestation and can be severe and recurrent in young patients. Early recognition and targeted thrombophilia testing are essential, as APS accounts for a significant proportion of unprovoked VTE in this age group. Management requires long-term anticoagulation with vitamin K antagonists due to the high risk of recurrence. Multidisciplinary care and vigilant follow-up are crucial to prevent recurrence and long-term complications such as thromboembolic pulmonary hypertension.
Volume
212
First Page
2
