We present a patient with systemic lupus erythematosus who developed an anterior spinal artery syndrome (ASAS) in association with livedo reticularis, leg ulcerations and thrombocytopenia. Low serum titres of anticardiolipin antibodies were detectable throughout the course of this disease. The patient recovered from the first episode of ASAS under corticosteroid treatment but remained paralytic after a second episode. Repeated magnetic resonance imaging of the spinal cord failed to show altered signal intensity.