[Cutaneous nodular lesions and antiphospholipid syndrome]

Antiphospholipid antibodies are a group of autoimmune antibodies directed against a broad panel of phospholipids and their cofactors. Antiphospholipid antibody syndrome is defined by the presence of a hypercoagulable clinical state associated with antiphospholipid antibodies. We report a case with very unusual cutaneous nodular lesions.

A 37-year-old man presented with painful recurrent cutaneous lesions of the nape of the neck. The lesions appeared four years earlier and regressed with oral prednisone. The previous year, cerebral ischaemia revealed antiphospholipid syndrome and anticoagulant therapy was initiated. The patient's cerebral ischaemia was successfully treated but the skin lesions recurred in spite of good anticoagulation therapy. The nodules were strictly confined to the back of the neck. Histopathological examination of a nodular lesion from this patient revealed dilated arterioles and venules with luminal blockage due to fibrinoid thrombosis consistent with the thrombotic microangiopathy seen in antiphospholipid syndrome.

We describe a case of primary antiphospholipid syndrome with cutaneous lesions as the initial sign of the disease. These "Sweet-like" lesions have been described only once in the literature. Therapeutic strategy in the event of failure of anticoagulants is not well codified.