title: Lupus erythematosus with antiphospholipid syndrome and erythema multiforme-like lesions.
abstract: The occurrence of erythema multiforme (EM) in patients with lupus erythematosus (LE) has been described previously as a coincidental association. In contrast, LE with EM-like lesions and a peculiar immunological pattern, including positive rheumatoid factor, antinuclear antibodies and a serum antibody against an extract of human tissues recently recognized as similar to Ro (SSA), constitutes an established entity named Rowell's syndrome. We describe a woman with LE and long-standing widespread vesiculobullous and necrotic haemorrhagic EM-like lesions in combination with Ro (SSA) and scl-70 antibodies and the typical laboratory findings of the antiphospholipid syndrome (APS), namely lupus anticoagulant, anticardiolipin antibodies and prolonged activated partial thromboplastin time. This case could conceivably be consistent with a diagnosis of Rowell's syndrome, if the latter is regarded as a clinicopathological spectrum. However, the coexistence of LE, persistent EM-like disease and incomplete APS may also fulfil the diagnostic criteria for the 'multiple autoimmune syndromes'. We speculate that the laboratory markers of APS play a pivotal part in such an unusual clinical presentation.
authors.affiliation: Institute of Dermatological Sciences, IRCCS, Ospedale Maggiore, Via Pace 9, 20122 Milan, Italy.
authors.forename: A V
authors.initials: AV
authors.lastname: Marzano
authors.forename: E
authors.initials: E
authors.lastname: Berti
authors.forename: G
authors.initials: G
authors.lastname: Gasparini
authors.forename: R
authors.initials: R
authors.lastname: Caputo
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000473:pathology; D004892:Erythema Multiforme / Q000150:complications* / Q000473:pathology; D005148:Facial Dermatoses / Q000150:complications*; D005260:Female; D006801:Humans; D007868:Leg Dermatoses / Q000150:complications*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000473:pathology; D012867:Skin / Q000473:pathology