Bucciarelli and colleagues analysed the clinical and laboratory characteristics of patients with catastrophic antiphospholipid syndrome (APS) and acute respiratory distress syndrome (ARDS).¹ They found that ARDS is the dominant pulmonary manifestation of catastrophic APS.

In their discussion the authors report on the paper by Maneta-Peyret et al,² who detected antilipid autoantibodies of the IgG class exclusively in the bronchoalveolar fluid (BALF) of patients with ARDS. These antibodies were directed against anionic phospholipids and reacted principally with phosphatidic acid. The antibodies showed significant binding on negatively charged phosphatidylserine and at a lower level on phosphatidylinositol in an enzyme linked immunosorbent assay (ELISA). These phospholipids occur in the pulmonary surfactant. Detection of antiphospholipid antibodies (aPL) in the BALF of patients with ARDS suggests involvement of …