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May 21, 1997

Antiphospholipid AntibodyBabies, Blood Clots, Biology

Author Affiliations

From the Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Md. Dr Lockshin is now with the Barbara Volcker Center for Women and Rheumatic Disease, The Hospital for Special Surgery-Cornell Medical Center, New York, NY.

JAMA. 1997;277(19):1549-1551. doi:10.1001/jama.1997.03540430061034

CASE PRESENTATION  At the age of 22 years, a Hispanic woman developed joint pain, fatigue, rash, and thrombocytopenia. Results of antinuclear and anti-DNA antibody tests were positive. Urinalysis and renal function test results were normal. Systemic lupus erythematosus (SLE) was diagnosed, and hydroxychloroquine sulfate and nonsteroidal anti-inflammatory drugs were prescribed. She did well until she was seen again at age 29 years, when she developed scotomata following a first-trimester spontaneous abortion. Findings of a neurological evaluation, including magnetic resonance imaging, electroencephalography, and Doppler studies, were unremarkable. At age 30 years, severe intrauterine growth restriction, hypertension, and proteinuria complicated a pregnancy, which ended with fetal death at 22 weeks.At age 32 years, the patient sought another opinion. This examination revealed normal vital signs, slight patches of malar erythema, lupus rash, livedo reticularis (Figure), and a loud apical systolic murmur. Her platelet count was 96X109/L. Prothrombin time was 13.0