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Foetal loss, liver necrosis and acute lupus erythematosus in a patient with antiphospholipid antibody syndrome

Medical Clinic B, University Hospital, Zurich, Switzerland; Department of Internal Medicine, University Hospital, Raèmistrasse 100, CH-8091 Zurich, Switzerland thomas.fehr{at}dim.usz.ch

G Cathomas

Department of Pathology, University Hospital, Zurich, Switzerland

C Weber

A Fontana

Division of Clinical Immunology, University Hospital, Zurich, Switzerland

A Schaffner

Medical Clinic B, University Hospital, Zurich, Switzerland

The antiphospholipid antibody syndrome (APS) is characterized by arterial or venous thromboses and recurrent foetal loss. It occurs as primary disease, but also in the context of systemic lupus erythematosus (SLE). Whereas primary APS induces a thrombotic microangiopathy without significant inflammatory reaction, secondary APS in SLE is usually associated with vasculitis. Here we report a patient with APS who presented with acute diarrhoea and then developed a HELLP-like syndrome characterized by a spontaneous abortion, multifocal hepatic necroses and thrombocytopenia. Thereafter an acute flare of SLE with arthralgias, pleuritis, skin rash and glomerulitis occurred. Clinical amelioration was only achieved by combining curettage, antic-oagulation and immunosuppression, a treatment taking into account the pathogenesis of HELLPlike disease, APS and SLE. To our knowledge this is the first reported case of APS associated with combined acute manifestations of these three syndromes triggered by a presumable intestinal infection.

Key Words: antiphospholipid antibody syndrome • foetal loss • liver necrosis • systemic lupus erythematosus • infection

Lupus, Vol. 10, No. 8, 576-579 (2001)
DOI: 10.1191/096120301701549606


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