Clinical Problem-Solving: Decision Making by Analogy

To the Editor: The patient with possible systemic lupus erythematosus described in the March 2 Clinical Problem-Solving article 1 most likely had primary or secondary antiphospholipid-antibody syndrome. 2 , 3 She had documented thrombi in both legs, along with an unexplained elevation in partial-thromboplastin time and a positive test for lupus anticoagulant. These serologic abnormalities, and occasionally a decrease in platelet count, are characteristic of antiphospholipid-antibody syndrome. A test for anticardiolipin antibodies was apparently not done. The antiphospholipid-antibody syndrome occurs in up to one third of patients with systemic lupus. 3 The presence of anticardiolipin antibodies would be consistent with this patient's clinical picture . . .