Autoerythrocyte sensitization (Gardner-Diamond) syndrome mimicking compartment syndrome

Role of Autoerythrocyte Sensitization Test in the Diagnosis of Recurrent Spontaneous Bruising

Introduction

Psychogenic purpura, also known as autoerythrocyte sensitization syndrome, is a rare condition which is characterized by spontaneous development of painful purpura, or ecchymoses. Skin lesions are usually preceded by stress and emotional trauma. It is usually a diagnosis of exclusion after ruling out history of trauma, drug intake and other bleeding disorders. Autoerythrocyte sensitization test (AEST) and a psychiatric evaluation helps in the diagnosis and treatment.

Objective

To demonstrate the importance of AEST in diagnosing the patient of Gardner Diamond syndrome.

Materials and Methods

Five suspected cases of autoerythrocyte sensitization syndrome underwent AEST after ruling out other causes of bleeding.

Results

Four out of five patients were positive for AEST while one patient was negative. Psychiatric complaints were present in three patients. One patient was lost to follow up. Rest all patients responded well to vitamin C supplementation.

Conclusion

Autoerythrocyte sensitization syndrome is a rare disorder and is a diagnosis of exclusion, so a thorough workup of the patient to rule out common causes of bruising is essential. A high index of suspicion on the clinician's part and a simple OPD-based AEST may help in the diagnosis. Psychiatric consultation is important to find out the stress factor and timely management.

[Gardner-Diamond syndrome in a young man: A case report and literature review]

INTRODUCTION

Gardner-Diamond syndrome is a rare condition secondary to a sensitization to self-erythrocytes. It is predominantly seen in women and presents as a painful ecchymotic disorder. An underlying psychiatric disease or a triggering psychological stress is of important diagnostic value.

CASE REPORT

We report a 24-year-old patient who presented with intermittent spontaneous painful ecchymosis since 5 years. Complementary investigations failed to identify an organic disorder. Gardner-Diamond syndrome was retained because of the clinical presentation, the negativity of diagnostic work-up and the identification of a psychological trauma. Patient management (pain, psychological support) is difficult, justifying a multidisciplinary approach.

CONCLUSION

Gardner-Diamond syndrome is a rare and unrecognized disorder, which should be discussed in the presence of ecchymotic or purpuric lesions that do not have a diagnostic orientation. Early recognition of this disorder enables initiation of an appropriate management, but also limits unnecessary additional explorations.

Psychogenic Purpura (Gardner-Diamond Syndrome)

Psychogenic purpura, also known as Gardner-Diamond syndrome or autoerythrocyte sensitization syndrome, is a rare condition characterized by spontaneous development of painful edematous skin lesions progressing to ecchymosis over the next 24 hours. Severe stress and emotional trauma always precede the skin lesions. The condition is most commonly seen in women, but isolated cases have been reported in adolescents and in males. Psychodermatologic evaluation and dermatology and psychiatry liaison have been successful in the treatment of these patients. This report provides an overview of psychogenic purpura and presents the case of a 15-year-old girl.

Autoerythrocyte sensitization syndrome presenting with general neurodermatitis

Autoerythrocyte sensitization syndrome (AES) was first described by Gardner and Diamond in 1955, when four women with painful bruising were depicted. Patients with AES typically present with the development of recurrent, spontaneous, painful ecchymosis, frequently preceded by a prodrome of pain or itching of the skin. The patients are sensitive to their own red blood cells injected intradermally, and underlying coagulopathies are thought to be absent. We introduce a 70-year-old woman presenting with recurrent episodes of painful bruising on the trunk and extremities.

Autoerythrocyte sensitization syndrome presenting with general neurodermatitis: factitious purpura or psychophysiological entity?

Autoerythrocyte sensitization syndrome (AES) is a disorder characterized by recurrent, spontaneous, painful bruising in patients with underlying psychosis and neurosis. Its pathogenesis is uncertain. Purpuric lesions reproduced by injections of washed autologous erythrocytes suggest an autoimmune etiology. The authors described a 50-year-old woman who presented with recurrent episodes of painful bruising for 8 months, along with a 2-year history of general chronic neurodermatitis. A diagnosis of AES was made on the basis of the clinical symptoms and laboratory examinations results: the positive autoerythrocyte sensitization test and psychophysiologic derangement. However, the noticeable symptoms, simultaneously identical distribution of the ecchymosis and neurodermatitis lesions, as well as concomitant symptom of itching over the ecchymosis, created doubts regarding the real etiopathogenesis of the ecchymosis and whether the ecchymosis in the present patient were just factitious purpura. The authors discuss the rarity of this case, which to the authors’ knowledge, had not been previously reported in the literature.

Autoerythrocyte sensitization syndrome associated with grief complications

The clinical presentation of a patient with autoerythrocyte sensitization syndrome associated with a complicated grief reaction is reported. A 50-year-old female patient presented with recurrent episodes of painful ecchymotic bruising on the lower extremities which started in 1995 after the sudden death of her son and exacerbated almost every year at approximately the same time her son died as an anniversary reaction. No pathological findings were detected in the laboratory examinations. The diagnosis was confirmed by induction of similar lesions by i.d. injection of the patient's own washed erythrocytes and whole blood. Psychiatric assessment revealed that the patient was depressed, socially introverted, overly defensive and avoidant in interpersonal relationships. Antidepressant treatment and psychotherapy for major depression and grief complications were started with the patient. Having an awareness of this rare condition will assist in the prevention of unnecessary investigations in such cases and will allow early referral for appropriate psychological counseling.

[Painful bruising syndrome: a psychogenic disease]

INTRODUCTION

Painful bruising syndrome was described by Gardner and Diamond in 1955. It is marked by spontaneous bruising, without any biological abnormality, affecting young women with pathological mental context.

EXEGESIS

We report three observations with painful bruising syndrome. In a patient, psychotherapy induced improvement in dermatological and articular manifestations. In other case, placebotherapy made clinical symptoms go away for a prolonged period.

CONCLUSION

Some etiological hypotheses have been postulated for Gardner and Diamond syndrome. However, published cases speak in favour of psychogenic hypothesis. Somatic and psychological approach must be offered to these patients.