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Anti-Phospholipid Antibodies: Clinical Complications Reported in Medical Literature
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
The association of livedo reticularis with cerebrovascular ischemia, transient ischemic attacks (TIAs), strokes, often accompanied by hypertension was first documented by Champion and Rook in I96031 but the eponym of “Sneddon’s” syndrome has been associated with these clinical manifestations since his description of this condition several years later.32 There have been many reports of this association since then.32-36 Although the cause of the condition is unknown, occlusion of small- and medium-size arteries seems to be pathogenetic mechanism. Non-SLE patients with the lupus anticoagulant and aCL antibodies have been subdivided into those closely linked to SLE and termed “lupus-like” disease (LLD) and those with a “primary” anti-phospholipid syndrome (PAPS) which has recently been defined.37 It appears that a proportion of patients with Sneddon’s syndrome are in fact examples of this latter condition. There have been several case reports confirming the association. Jonas et al.38 reported the occurrence of a retinal artery occlusion in such a patient while the patient reported by Gratton et al.39 had previously suffered an arterial occlusion and incipient gangrene of a toe which resolved with two pulses of methyl prednisolone. Skin biopsy from the livedinous area showed intimai hyperplasia and mid-dermal vessel biopsy revealed endothelial cell proliferation with almost complete luminal occlusion in places.39 Other authors have also questioned whether some examples of Sneddon’s syndrome are associated with aPL antibodies40 and this has been the subject of recent correspondence in several international journals.41,42
Antiphospholipid syndrome: the need for new international classification criteria
Published in Expert Review of Clinical Immunology, 2021
Georges El Hasbani, Ali T Taher, Savino Sciascia, Imad Uthman
The neurological manifestations of APS can be either thrombotic or non-thrombotic. Thrombotic manifestations including acute ischemic stroke, transient ischemic attack (TIA), and cerebral venous thrombosis (CVT) are common among APS patients, and their inclusion in any new classification is unquestionable [46]. Sneddon’s syndrome has also been reported as a thrombotic neurological manifestation of APS. Although aPL can be detected in up to 80% of Sneddon’s syndrome patients [47], this syndrome remains rare. Therefore, much more data are needed to determine the role of aPL in Sneddon’s syndrome. Similarly, the data on the association of reversible cerebral vasoconstriction syndrome with aPL are still scarce.