[Improvement of cerebral perfusion with argatroban in a patient with antiphospholipid syndrome]

A 22-year old woman developed erythema in her hands. She also suffered from general fatigue and arthralgia. In July of 1992, she visited the dermatology clinic of Nagoya City University Hospital. We made a diagnosis of subacute cutaneous lupus erythematosus with thrombocytopenia and gave her 30 mg of prednisolone daily. Her conditions were improved and had been stable with 5 mg of prednisolone daily. In the winter of 1993, she developed ulcer in her fingers and soles. These lesions were associated with antiphosholipid syndrome. She complained of mild headache. She was examined by CT, MRI and single photon emission computerized tomography (SPECT) using N-isopropyl-p-[123I] iodoamphetamine (IMP). Low perfusion areas in the bilateral occipital lobes and the right temporal lobe were found in SPECT, although no abnormalities were detected by CT and MRI. Low perfusion areas in antiphospholipid syndrome might be caused by microarterial thrombosis, microvenous thrombosis or spasms, although they could be reversible. Ten mg of argatroban daily for one month improved cerebral low perfusion, headache, and skin lesions. In this case, argatroban was effective for both cerebral low perfusion and skin ulcer, which were related to antiphospholipid syndrome.