Achenbach's syndrome (paroxysmal finger hematoma) with capillaroscopic evidence of microhemorrhages

Achenbach Syndrome: Case Report and Discussion

Achenbach syndrome is a rare, benign, self-limiting condition characterized by spontaneous, recurrent bruising of the digits without evidence of systemic disease or predisposing factors. We report a middle-aged Caucasian female that presented to the outpatient clinic with spontaneous bruising on the dorsal aspect of her left first metacarpal. Diagnosis of Achenbach syndrome was made through history and physical examination findings, and the patient was discharged with instructions to follow up as needed. It is important for providers to consider Achenbach syndrome to reassure patients and prevent an expensive or invasive workup.

Achenbach Syndrome: A Case Series

Achenbach syndrome, also known as "paroxysmal finger haematoma", is a rare, benign, self-limiting condition with unknown etiology that results in an acute onset swelling and pain, and subsequently blue discoloration of the fingers and sometimes the feet. The pathophysiology of this syndrome is not entirely clear, but intermittent spontaneous hematoma formation is reported as its characteristic symptom. Achenbach syndrome is more predominant in the female population. There are no known risk factors such as trauma, drug use, bleeding disorders, or rheumatologic diseases associated with the etiology of this syndrome. Although the symptoms are alarming to patients, the condition itself is not accompanied by any significant complications.

Herein we present our case series of four patients experiencing symptoms compatible with the diagnosis of Achenbach syndrome. The aim of this study is to increase awareness of this condition and its benign nature to avoid unnecessary referrals or invasive procedures and investigations as well as alleviate the anxiety of patients.

Achenbach’s Syndrome Revisited: The Paroxysmal Finger Hematoma May Have a Genetic Link

Achenbach’s syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2–3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach’s syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations.

Achenbach syndrome as a rare cause of painful, blue finger

Paroxysmal finger hematoma, also known as Achenbach syndrome, is an underdiagnosed condition that causes apprehension in patients owing to the alarming appearance. It usually presents as a blue-purple discoloration of the volar aspect of one or more digits and can be associated with pain and paresthesia. This condition is benign and is usually self-limiting.

Achenbach Syndrome: A Benign Painful Blue Finger with Tip Sparing

Vascular surgeons are often consulted for patients with spontaneous painful discoloration of fingers and toes. In most cases, no diagnosis can be ascertained after extensive investigations and the condition resolves spontaneously. Awareness of Achenbach syndrome among physicians may help mitigate anxiety in patients because it is relatively benign and has a good prognosis. This report presents a case of Achenbach syndrome in an Asian woman along with a literature review.

An Acute Blue Finger: A Case of Achenbach's Syndrome

Achenbach’s syndrome, also known as paroxysmal finger haematoma, is a rare condition that results in spontaneous bruising and pain in one or more fingers. Despite its benign and self-limiting course, the remarkable clinical presentation can suggest serious vascular and haematological disease leading to unnecessary referrals and invasive investigations. The authors present the case of a 60-year-old woman with an acute painful and bruised finger. All other physical findings and investigations were normal, except for autoimmune thyroiditis. Based on the clinical presentation and course, the diagnosis of Achenbach’s syndrome was made and the symptoms resolved without treatment.

Achenbach syndrome (paroxysmal finger hematoma)

Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the subsequent appearance of a hematoma on the palmar side of the proximal phalanges. Achenbach syndrome is a benign condition of unknown etiology in which prodromal symptoms, such as pain, tingling, and itching, may occur from minutes to hours before the color change appears. The subdermal bleeding usually stops spontaneously or after local pressure is applied. The color changes usually disappear within a few days, without permanent sequelae. The diagnosis of Achenbach syndrome is based strictly on its clinical features because the results of all routine investigations are usually normal. Physicians should become aware of this condition in order to advise their patients about its benign prognosis and to avoid unnecessary testing.

Analysis of 24 patients with Achenbach's syndrome

BACKGROUND

Achenbach’s syndrome is a rare condition, and the etiology is unknown. It is most commonly seen in the volar plate of the hand distal interphalangeal joint. Patients diagnosed with Achenbach’s syndrome in cardiovascular surgery clinic were retrospectively compared with the literature.

AIM

To investigate the symptoms, findings, sociodemographic conditions, and laboratory data of patients diagnosed with Achenbach’s syndrome.

METHODS

The study is a retrospective review of 24 patients diagnosed with Achenbach’s syndrome at Afyonkarahisar State Hospital between March 2015 and November 2016, at Sivas Numune Hospital between November 2016 and November 2017, and at Cumhuriyet University Cardiovascular Surgery Department between November 2017 and November 2018. In the study, demographic characteristics of the patients, signs and symptoms of the disease, and laboratory data were analyzed retrospectively.

RESULTS

The cohort consisted of 83.33% female patients and 16.67% male patients. The disease was most commonly located in the index finger of the right hand. All of the patients complained of bruising and pain. No pathologic findings were present in the laboratory results. According to these results, it can be concluded that Achenbach syndrome is most commonly seen in the right index finger of middle-aged female patients.

CONCLUSION

Further research is needed to clarify Achenbach’s syndrome and to develop a diagnosis and treatment algorithm. As the awareness of this syndrome increases, large amounts of data will be obtained. According to current knowledge, Achenbach’s syndrome is not among the known causes of mortality or morbidity. However, it is unknown whether it is seen in brain or other vital organs.

Painful Blue Finger-Achenbach's Syndrome: Two Case Reports

Introduction

Herein, two cases of a rare, self resolving condition are described. Vascular surgeons are often called to see patients with spontaneous discolouration of extremities and digits. Often after extensive investigations no diagnosis can be ascertained and the condition resolves spontaneously.

Report

Two cases are described here, which presented with spontaneous onset of this condition and after extensive testing no cause was ascertained. The condition resolved spontaneously.

Discussion

Achenbach's syndrome is a benign, self-limiting condition of unknown aetiology and clinicians should be aware of it to avoid unnecessary time consuming and expensive investigations.

•

Rare disorder.

•

Importance of clinical examination.

•

Avoidance of unnecessary tests.

[Paroxysmal finger haematoma (Achenbach syndrome)]

BACKGROUND

Paroxysmal finger haematoma (also known as "Achenbach syndrome") is a benign condition resulting in the sudden appearance of bruising on one or more fingers, either spontaneously or after minimal trauma, and resolving without treatment. To date, less than 40 cases have been reported.

PATIENTS AND METHODS

We report two cases of women aged over 50 years presenting for sudden onset of digital haematomas occurring spontaneously without any prior trauma. Laboratory and radiological tests appeared to be normal for both patients. History-taking and clinical and laboratory data pointed towards a diagnosis of spontaneous paroxysmal finger haematoma. Each episode resolved spontaneously but, as is generally seen, recurrences occurred during follow-up.

DISCUSSION

In the absence of known aetiologies and/or treatments for spontaneous paroxysmal finger haematomas, a knowledge of this rare condition can at least help doctors reassure their patients by diagnosing their condition and pointing out the benign nature thereof. It also helps avoid costly and unwarranted additional investigations.

Is Achenbach's syndrome a surgical emergency? A systematic review

AIM

The aim of this study is to establish the nature (urgent vs. non-urgent), demographics, presentation and management of Achenbach's syndrome and to formulate an algorithmic approach for their diagnosis and management.

MATERIALS AND METHODS

A systematic review and met-aggregation of literature from 1944 to 2015 in English language in MedLine, Embase and Cochrane database were conducted.

RESULTS

Achenbach's syndrome is a female-dominant disease with median age of 49.5 years (range 22-76) (age ≤60, n = 11/12, 91 %). It presents with unilateral volar discoloration of a finger (100 %). It is associated with pain (n = 7/12, 58. %), edema (n = 7/12, 58 %), and paresthesia (n = 3/12, 25 %). The median time to resolution of symptoms without any intervention was 4 days (range 2-14).

CONCLUSION

AS is self-limiting and a non-urgent surgical condition. It can be differentiated from other pathologies by clinical spectrum, patient demographics and in doubtful circumstances (acute limb ischemia) by Doppler sonography. An algorithmic approach can avoid hospital admissions, partially unnecessary investigation and assist in patient assurance.