 Catastrophic antiphospholipid syndrome, CAPS-E is a rare but life-threatening autoimmune disease caused by the presence of antiphospholipid antibodies. These antibodies cause disseminated intravascular thrombosis, leading to organ failure and death if not treated promptly. Symptoms include fever, fatigue, headache, muscle aches, and skin rash. Laboratory tests may show low white blood cell count, elevated levels of certain antibodies, and abnormal clotting factors. Treatment includes anticoagulation therapy, immunosuppressive drugs, plasma Pharisees, and intravenous immunoglobulins. This article was authored by Ali Nair and Luis M. Ortega.