Refractory hiccough heralding transverse myelitis in the primary antiphospholipid syndrome

The case of a 32-year-old female patient with a primary form of the antiphospholipid syndrome is presented. The initial symptom was a pathological form of hiccough, refractory to conventional therapy that was followed, weeks later, by a full-blown picture of transverse myelitis. Despite the fact that transverse myelitis has been described as associated with the presence of antiphospholipid antibodies, we could not find the description of refractory hiccough as the initial manifestation of the antiphospholipid syndrome. The administration of steroids, heparin and plasmapheresis resulted in resolution of the neurological symptoms.