Vascular occlusions in a patient with low positive antiphospholipid antibodies and subsequent development of breast carcinoma: a diagnostic dilemma.

A 61-year-old female with a history of previous digital ischemia and stroke, developed bilateral brachial artery thromboses thought originally to be due to fibromuscular hyperplasia. Histology from one artery revealed bland thrombi only with no evidence of vasculitis. Minimal elevations of anti-B2GP1 were demonstrated with levels of other isotypes measurable at just below cut off levels for normality. Three months later, she developed carcinoma of the breast, which required surgical treatment followed by chemotherapy. Three years later, all aPl determinations were negative with levels well below the cutoff levels for all isotypes. The minimal anti-B2GP1 elevation may have been triggered by the vascular damage caused by the thromboses or may perhaps have been pathogenic in the causation of these thromboses. An alternative explanation is that the antibodies may have presaged the development of the malignancy. To favour any one of these explanations remains highly speculative.