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Cutaneous involvement in primary and secondary antiphospholipid syndrome often is a therapeutical dilemma. Here we describe a case of widespread cutaneous necrosis due to thrombosis of the microvasculature, and cutaneous vasculitis in secondary antiphospholipid syndrome in a patient with systemic lupus erythematosus. Autologous skin transplantation was able to cover the skin defects but was only successful in the presence of immunosuppressive treatment with glucocorticoids and cyclosporin A.
A 34 year old women was admitted to hospital because of widespread necrosis of the skin and muscle of both legs. She had a two year history of seronegative non-erosive polyarthritis of the knees, proximal interphalangeal and metacarpophalangeal joints, which was successfully treated with methotrexate 10 mg by mouth once a week. She complained about Raynaud's symptoms and dryness of the mouth but previously had no skin rash, fever, photosensitivity, ulceration of the oral or genital mucosa, or signs of pleuritis, pericarditis, or neurological abnormalities. She did not have children and had no history of fetal loss, thromboembolic events, or other disorders.
Four weeks before she was referred to us, she suddenly noticed blue patchy skin lesions on the extensor surfaces of her arms and legs. The skin lesions on the arms subsided, but on the …