Chorea as an unusual presenting feature of anti-phospholipid syndrome

Anti-phospholipid syndrome (APS) can manifest as primary disease or secondary to connective tissue diseases, such as systemic lupus erythematosus (SLE). It is characterized by recurrent arterial or venous thrombosis, thrombocytopenia, haemolytic anaemia, or positive Coombs' test, and recurrent pregnancy loss in females. Common neurological abnormalities include stroke, cognitive deficits and white matter lesions. We present an unusual case of secondary APS associated with SLE, that presented at our clinic with chorea. To the best of our knowledge this is a first such case reported from Pakistan. APS must be ruled out in any patient of SLE who presents with stroke or any other neurological abnormality regardless of the age at presentation. Moreover, unusual neurological presentations, such as chorea, should always be kept in mind in order to promptly diagnose and treat APS owing to its high morbidity and mortality.