Over the past decade the antiphospholipid syndrome (APS) was defined by the presence of antiphospholipid antibodies (aPL) and clinical manifestations including thrombosis, recurrent fetal loss, thrombocytopenia, chorea, livedo reticularis, heart valve lesions, and renal involvement.1 Asherson et al first drew attention to a catastrophic variant of APS (CAPS) that is characterised by multiple widespread vascular occlusions, leading to multiple organ failure and often death.2 We describe two non-systemic lupus erythematosus (SLE) patients with a strikingly similar clinical presentation of CAPS and emphasise the difficulties in differentiating CAPS from other thrombotic angiopathies.