Background: Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening variant of antiphospholipid syndrome characterized by rapid multi-organ thrombosis. Its precipitation by progestogen therapy in young women with underlying thrombophilia remains underrecognized.Case Presentation: A 20-year-old woman with polycystic ovary syndrome (PCOS), treated with dydrogesterone 10 mg daily for two months, was admitted for extensive right iliac deep vein thrombosis extending to the inferior vena cava. After five days of anticoagulation, she re-presented with chest pain. Investigations revealed positive troponins, inferolateral ECG changes, apical akinesia on echocardiography (LVEF 59%), and patent coronary arteries on angiography. Left ventriculography was consistent with Takotsubo cardiomyopathy. Laboratory evaluation confirmed CAPS. The course was complicated by severe femoral puncture-site hemorrhage and epigastric artery bleeding in the context of extreme thrombocytopenia (platelets: 2,000/µL). The patient responded markedly to intravenous immunoglobulin (IVIG) therapy.Conclusion: Early recognition of CAPS is crucial, as prompt initiation of combined immunomodulatory and anticoagulant therapy significantly improves prognosis.