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Antiphospholipid Syndrome — SCE Dermatology MCQ

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ModerateConnective Tissue & VasculitisAntiphospholipid SyndromeSCE Dermatology

A 35-year-old woman with SLE develops livedo reticularis and recurrent deep vein thrombosis. She is found to have persistently positive lupus anticoagulant and anti-cardiolipin antibodies on two occasions 14 weeks apart. She has had one miscarriage. What is the diagnosis according to the revised Sapporo classification criteria?

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Correct answer: E — Secondary antiphospholipid syndrome (associated with SLE)

The revised Sapporo (Sydney) classification criteria for definite APS require at least one clinical criterion (vascular thrombosis OR pregnancy morbidity) AND at least one laboratory criterion (lupus anticoagulant, anti-cardiolipin IgG/IgM, or anti-beta2-glycoprotein I IgG/IgM — positive on 2 occasions ≥12 weeks apart). This patient fulfils both clinical (DVT) and laboratory (persistent lupus anticoagulant + anti-cardiolipin) criteria. When APS occurs with an underlying autoimmune disease (SLE), it is classified as secondary APS. Cutaneous features of APS include livedo racemosa, digital gangrene, livedoid vasculopathy, skin ulcers, and splinter haemorrhages. Treatment is long-term anticoagulation.

Reference: BAD 2017; ACR/EULAR APS Classification 2023