The authors present a case of myocardial infarction in a 26-year-old man with antiphospholipid syndrome (APS) and a history of recent cocaine use. His only traditional cardiovascular risk was that he smoked. The authors propose that his cocaine use and APS brought about a potentially catastrophic cardiac event despite therapeutic anticoagulation. This was supported by the finding of normal coronary arteries on angiography despite both a significant regional wall motion abnormality on echocardiography and a significant rise in Troponin I. This case suggests the presence of a synergistic effect between cocaine and antiphospholipid antibodies. (Lupus (2007) 16, 444—446)
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