Lupus erythematosus with antiphospholipid syndrome and erythema multiforme-like lesions

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.