Clinical and Experimental Dermatology 1992; 17: 266 269.

Skin nodules and macules resembling vasculitis in the antiphospholipid syndrome—a report of two cases R.A.ASHERSON, S.JACOBELLI,* H.ROSENBERG,f P.MCKEEt AND G.R.V.HUGHES The Li/pusi.'irthriiis Research Unit, The Raync Instttule, St Thomas' Hospital London, *Divtsion of Medtcine and \Departmenl of Histopathology, Catolica University of Chile. Santiago, \Departnieut of Histopathology, St Thomas' Hospital, London Accepted for publication 23 September 1991

Summary

placed on long-term anticoagulant therapy and the Two patients who demonstrated skin lesions in the prednisolone was continued until 1988. The painful skin presence of antiphospholipid antibodies are documented. nodules reappeared and their appearance seemed to be The first had a h)ng history (tf recurreni painful nodules. related to the menses. A biopsy performed in 1989 She had also suffered two deep vein thromboses. The revealed a thrombotic microangiopathy (Fig. I a-d) and second developed a rash on the lower limbs resemblitig she was then treated with low-dose salicylate therapy. vasculitis which did not respond to prednisolone, but to Her immunology showed absence of antibodies to low dose salicylate therapy. Histology in both patients double-stranded deoxyribonucleic acid (dsDNA) and to extractable nuclear antigens (ENA), negative anrinuclear revealed microthrombosis of cutaneous vessels. antibodies (ANA), but a low C4 component of complement (013 g/1: H-O15-()5 g/l) as well as a low C3 component (0 60 g/1: «^0 85-2 0 g/1). She was anaemic, Over the past few years since the description of the her haemoglobin being 84 g/dl (ff^ll-5-15-5 g/dl) with antiphospholipid syndrome (APS) in 1985' there have anisocytosis, microcytosis and hypochromia (she suffered been several reports of thrombotic skin lesions associated from menorrhagia). The ESR was elevated at 28 mm/h. with antiphospholipid antibodies (aPI.)—those respon- The platelet count was normal at 331 x Wj\ ( n ^ l 5 0 sible for the 'lupus anticoagulant' test as well as anti- 400X lO'Vl). The lupus anticoagulant test was negative, bodies directed against negatively charged phosphohpids, but antibodies to cardiolipin were grossly elevated with of which cardiolipin is an example (a(J.). We wish to an IgG aCI, of 172 9 units and IgM aCE of 68 6 units. document two further patients with aPL related skin There was elevation of liver enzymes. The alanine manifestations—one presenting with painful erythema- transferase was elevated at 74 IU/1 ( « ^

Skin nodules and macules resembling vasculitis in the antiphospholipid syndrome--a report of two cases.

Two patients who demonstrated skin lesions in the presence of antiphospholipid antibodies are documented. The first had a long history of recurrent pa...
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