Prevalence and clinical significance of subungual splinter haemorrhages in patients with the antiphospholipid syndrome

Abstract

Objective: To assess the prevalence and clinical significance of subungual splinter haemorrhages in patients with the antiphospholipid syndrome.

Methods: A group of 147 patients with the antiphospholipid syndrome (124 female, 23 male) were studied. All patient histories were carefully reviewed and each patient was interviewed at least once. Particular attention was paid to clinical manifestations of the antiphospholipid syndrome at the time of subungual splinter haemorrhages. Patients who had evidence of infective endocarditis confirmed by echocardiogram and a positive blood culture were excluded from the study.

Results: Six out of 147 patients developed subungual splinter haemorrhages. Amongst 80 patients (54%) with a history of venous thrombosis, only one developed subungual splinter haemorrhages during a lupus flare in the post-partum period. This sign was found in 4 out of 67 patients with arterial occlusions; in 2 of these the occlusion manifested as a cerebrovascular accident. Another patient with a history of lupus and recurrent miscarriages developed subungual splinter haemorrhages during a lupus flare.

Conclusion: Subungual splinter haemorrhages appeared to be relatively uncommon in our group of patients with the antiphospholipid syndrome. The differences in clinical setting and response to different treatment regimes in these cases suggest varied aetiopathologies and may reflect a number of different types of vascular insult.