Are anticardiolipin antibodies thrombogenic in human immunodeficiency virus infection?

Lupus-like anticoagulant is commonly encountered in human immunodeficiency virus infection although thromboembolic manifestations are rare in HIV pati ents. We report the case of an HIV patient who developed gangrene of both f orefeet associated with anticardiolipin antibodies. A 42-year-old woman had a 12-year history of HIV infection (stage B2). She presented with painful gangrene involving the forefeet of 4-day duration. D oppler ultrasonography, electromyography and nailfold capillaroscopy were n ormal. Skin biopsy revealed intracapillary thrombi and severe necrosis with in the hypodermis; there was no evidence of vasculitis. Laboratory findings showed a marked inflammatory syndrome and the presence of anticardiolipin antibodies (IgG: 22 GPL U/ml). Several cutaneous manifestations are known to be associated with antiphosph olipid syndrome, such as livedo reticularis, ulcers and gangrene of the ext remities. Skin biopsy often shows noninflammatory thrombosis of small vesse ls within the dermis. Microcirculation damages have also been described in HIV infection, mainly vasculitis. In the present case report, the absence o f both vasculitis and other causes suggest that anticardiolipin could be th e culprit. But, it is possible that painful gangrene of the forefeet was se condary to HIV infection.