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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 49-year old woman with no medical history was admitted for a hysterectomy due to fibroids&#46; Necrotic purpuric lesions were observed in the fifth toe of the right foot &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; and livedo racemosa&#47;livedo reticularis lesions on the thighs&#44; hands and feet &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; These lesions caused paresthesia and coldness&#44; with preserved pulses&#46; The patient complained of tremors&#44; loss of strength in the right hand and headaches in the past year&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We performed 2 skin biopsies of the left thigh&#44; which showed minimal perivascular lymphocytic infiltrates in the superficial dermis&#44; with no thrombi in the vascular lumens &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The laboratory study showed triple positivity at high titers of antiphospholipid antibodies&#58; anticardiolipin antibodies&#44; anti-beta-2-glycoprotein 1 and lupus anticoagulant&#44; which was subsequently confirmed in a second reading&#44; with negative antinuclear antibodies&#46; We also performed a transthoracic and transesophageal echocardiogram&#44; which showed images suggestive of thrombotic endocarditis in the mitral valve &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; In the brain angio-magnetic resonance&#44; we observed brain lesions suggestive of previous embolisms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; With these findings&#44; we established the diagnosis of antiphospholipid syndrome and started treatment with anticoagulation and antiplatelet agents&#44; which showed good progress&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Antiphospholipid syndrome or Hughes syndrome is a systemic autoimmune disease characterized by arterial thromboembolic&#44; venous and microcirculation events and morbidity during pregnancy in the presence of persistent antiphospholipid antibodies&#46; The clinical manifestations are varied&#44; with the skin type being very common&#46; Up to 50&#37; of such patients present skin manifestations&#44; which can be the first or only symptom&#46; A correlation has been observed between the presence of <span class="elsevierStyleItalic">livedo reticularis</span> and arterial thrombosis&#44; cardiac abnormalities and central nervous system disorders&#46;</p></span>"
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Medicine in Images
DOI: 10.1016/j.rceng.2019.01.016
Antiphospholipid syndrome: The importance of skin manifestations
Síndrome antifosfolípido: la importancia de las manifestaciones cutáneas
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M. Matellanes Palaciosa,
Corresponding author
mariamatellanes@hotmail.com

Corresponding author.
, E. Quecedo Estébaneza, S. Añon Roigb
a Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, Spain
b Servicio de Medicina Interna, Hospital Arnau de Vilanova, Valencia, Spain

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