PREVALENCE AND CLINICAL-SIGNIFICANCE OF SUBUNGUAL SPLINTER HEMORRHAGES IN PATIENTS WITH THE ANTIPHOSPHOLIPID SYNDROME

Objective. To assess the prevalence and clinical significance of subun gual splinter haemorrhages in patients with the antiphospholipid syndr ome. Methods. A group of 147 patients with the antiphospholipid syndro me (124 female, 23 male) were studied. All patient histories were care fully reviewed and each patient was interviewed at least once. Particu lar attention was paid to clinical manifestations of the antiphospholi pid syndrome at the time of subungual splinter haemorrhages. Patients who had evidence of infective endocarditis confirmed by echocardiogram and a positive blood culture were excluded from the study. Results. S ix out of 147 patients developed subungual splinter haemorrhages. Amon gst 80 patients (54%) with a history of venous thrombosis, only one de veloped subungual splinter haemorrhages during a lupus flare in the po st-partum period. This sign was found in 4 out of 67 patients with art erial occlusions; in 2 of these the occlusion manifested as a cerebrov ascular accident. Another patient with a history of lupus and recurren t miscarriages developed subungual splinter haemorrhages during a lupu s flare. Conclusion. Subungual splinter haemorrhages appeared to be re latively uncommon in our group of patients with the antiphospholipid s yndrome. The differences in clinical setting and response to different treatment regimes in these cases suggest varied aetiopathologies and may reflect a number of different types of vascular insult.