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ACL: anticardiolipin antibody anti-b2GPI: antieb2-glycoprotein antibody aPL: antiphospholipid antibodies APS: antiphospholipid syndrome DIF: direct immunofluorescent LA: lupus anticoagulant INTRODUCTION Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies (aPL) associated with thrombosis or pregnancy morbidity. These antibodies include lupus anticoagulant (LA), anticardiolipin antibody (ACL), and antieb2-glycoprotein antibody (anti-b2GPI). APS can be either primary or secondary to autoimmune diseases, mainly to systemic lupus erythematosus, but it can also be associated with other autoimmune, malignant, or drug-induced diseases. The condition affects the skin in 70% of cases, producing a variety of skin lesions. Livedo reticularis is the most frequently observed lesion; other types of lesions include ulcerations, digital gangrene, subungual splinter hemorrhages, superficial venous thrombosis, thrombocytopenic purpura, pseudovasculitic manifestations, and primary anetoderma. Disseminated cutaneous necrosis with dermal vascular thrombosis have been described on rare occasions. We present a case of extensive disseminated cutaneous necrosis. The C3 endothelial deposits observed in thrombotic vessels support the hypothesis of complement activation as a primary phenomenon in the development of cutaneous thrombosis.

Purpura fulminans–like lesions in antiphospholipid syndrome with endothelial C3 deposition