Review Question - QID 210816

This patient with thrombophlebitis, recurrent fetal loss, and a livido reticularis rash on her extremities most likely has antiphospholipid syndrome, which is associated with anti-cardiolipin antibody.

Antiphospholipid syndrome is an autoimmune disorder that is often associated with systemic lupus erythematosus (SLE), characterized by thromboses and recurrent spontaneous abortions. Its pathogenesis involves autoantibodies such as lupus anticoagulant, anti-cardiolipin, and anti-β2 glycoprotein that react against platelet membranes or the prothrombin-platelet membrane complex. This autoimmune reaction subsequently activates endothelial cells and platelets leading to the coagulopathic effects that are seen in this disorder.

Incorrect Answers:
Answer 2: Anti-centromere antibodies would be associated with limited scleroderma (CREST syndrome); however, this disorder would not present with recurrent fetal loss and thrombosis.

Answer 3: Anti-helicase antibodies would be associated with dermatomyositis and polymyositis; however, this disorder would not present with recurrent fetal loss and thrombosis.

Answer 4: Anti-histone antibodies would be associated with drug-induced lupus; however, there is no indication that this patient has taken any drugs that would lead to lupus such as procainamide.

Answer 5: Anti-ribonucleoprotein antibodies would be associated with Sjogren syndrome and mixed connective tissue disease; however, these disorders would not present with recurrent fetal loss and thrombosis.

Bullet Summary:
Antiphospholipid syndrome is associated with autoantibodies such as lupus anticoagulant and anti-cardiolipin.