The occurrence of erythema multiforme (EM) in patients with lupus erythemat
osus (LE) has been described previously as a coincidental association. In c
ontrast, LE with EM-like lesions and a peculiar immunological. pattern, inc
luding positive rheumatoid factor, antinuclear antibodies and a serum antib
ody against an extract of human tissues recently recognized as similar to R
o (SSA), constitutes an established entity named Rowell's syndrome. We desc
ribe a woman with LE and long-standing widespread vesiculobullous and necro
tic haemorrhagic EM-like lesions in combination with Ro (SSA) and scl-70 an
tibodies and the typical laboratory findings of the antiphospholipid syndro
me (APS), namely lupus anticoagulant, anticardiolipin antibodies and prolon
ged activated partial thromboplastin time. This case could conceivably be c
onsistent with a diagnosis of Rowell's syndrome, if the latter is regarded
as a clinicopathological spectrum. However, the coexistence of LE, persiste
nt EM-like disease and incomplete APS may also fulfil the diagnostic criter
ia for the multiple autoimmune syndromes'. We speculate that the laboratory
markers of APS play a pivotal part in such an unusual clinical presentatio
n.