SUMMARY A middle aged woman presented with acute, severe, intravascular coagulation leading to ischaemic necrosis of the extremities. Pulmonary involvement required artificial ventilation, and there was evidence of hepatic, pancreatic, and renal damage, which resolved without complication. These events may have been triggered by the ingestion of compound diuretic tablets. The finding of the 'lupus anticoagulant' and anticardiolipin antibodies, together with high titre antinuclear factor in the serum, and antibodies to extractable nuclear antigen (RNP), and a past history of spontaneous abortion, suggest that this was a dramatic manifestation of an immune connective tissue disorder.

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