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

The antiphospholipid antibody syndrome (APS) is characterized by arterial o r venous thromboses and recurrent foetal loss. It occurs as primary disease , but also in the context of systemic lupus erythematosus (SLE). Whereas pr imary APS induces a thrombotic microangiopathy without significant inflamma tory reaction, secondary APS in SLE is usually associated with vasculitis. Here we report a patient with APS who presented with acute diarrhoea and th en developed a HELLP-like syndrome characterized by a spontaneous abortion, multifocal hepatic necroses and thrombocytopenia. Thereafter an acute flar e of SLE with arthralgias, pleuritis, skin rash and glomerulitis occurred. Clinical amelioration was only achieved by combining curettage, anticoagula tion and immunosuppression, a treatment taking into account the pathogenesi s of HELLP-like disease, APS and SLE. To our knowledge this is the first re ported case of APS associated with combined acute manifestations of these t hree syndromes triggered by a presumable intestinal infection.