Antiphospholipid syndrome (APLS) is characterised by recurrent arterial or venous thrombosis. Deep veins, such as the femoral and popliteal veins are by far the commonest sites of thrombosis. The arterial and venous systems of the mesenteries, liver, kidneys and the adrenal glands are also involved.1 We report here a 39 year old woman with systemic lupus erythematosus (SLE) and secondary APLS who presented with subacute onset of back pain and was found to have avascular necrosis (AVN) of a single vertebral body at L2, an atypical presentation of this complication.

In 1976, a 17 year old white woman complained of gastrointestinal upset and frequent joint pain in her hands and knees a few months after she started taking oral contraceptives. She was found to have Coombs' positive haemolytic anaemia, leucopenia, thrombocytopenia and deranged liver function. Serologically, she had positive anti-nuclear antibody (ANA, 1/1280 on rat liver cells), anti-double stranded (ds) DNA antibodies (1/320 on Crithidia lucidiae) and positive anti-thyroid microsomal antibodies. Antibodies to the extractable nuclear antigens (ENA) were negative. Liver biopsy showed features compatible with chronic active hepatitis. SLE with an associated hepatitis was diagnosed and …