• Users Online: 1524
  • Print this page
  • Email this page


 
  Table of Contents  
THROUGH THE LENS
Year : 2017  |  Volume : 8  |  Issue : 6  |  Page : 521-522  

Gardner diamond syndrome: A psychogenic purpura


Department of Skin & VD, SCBMCH, Cuttack, Odisha, India

Date of Web Publication14-Nov-2017

Correspondence Address:
K Vivekanandh
Room no. 201, Metro Manorama Complex, Kathagola Road, Mangalabag, Cuttack, Odisha - 753 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_388_16

Rights and Permissions

How to cite this article:
Vivekanandh K, Dash G, Mohanty P. Gardner diamond syndrome: A psychogenic purpura. Indian Dermatol Online J 2017;8:521-2

How to cite this URL:
Vivekanandh K, Dash G, Mohanty P. Gardner diamond syndrome: A psychogenic purpura. Indian Dermatol Online J [serial online] 2017 [cited 2019 Dec 7];8:521-2. Available from: http://www.idoj.in/text.asp?2017/8/6/521/218337



A 35-year-old housewife presented with recurrent episodes of spontaneously appearing ecchymotic patches over lower extremities associated with pain and burning sensation of 6-months duration.[Figure 1]. Lesions resolve in 7–10 days leaving temporary hyperpigmentation. There was no prior history of trauma, menstrual irregularities, bleeding diathesis, any significant drug or family history. Other clinical examination was unremarkable. Complete blood cell count, coagulation profile and antinuclear antibodies were noncontributory. Intradermal injection of 0.1 ml autologous washed erythrocytes on flexure aspect of the left forearm caused an ecchymotic patch of approximately 2cm diameter in 2 hours [Figure 2]. Based on the above findings a final diagnosis of Gardner–Diamond syndrome was made.
Figure 1: Ill-defined ecchymotic patch of 2-5 cm size over the left thigh

Click here to view
Figure 2: Positive auto-erythrocyte sensitization test compared to control (normal saline) over the left forearm

Click here to view


Psychiatric consultation revealed symptoms suggestive of mixed anxiety depression disorder. Treatment was initiated with tablet Amytriptyline 10 mg and Clonazepam 0.5 mg. There was no further new episodes during a follow-up period of 6 months.

Auto-erythrocyte sensitization syndrome, also known as Gardner–Diamond syndrome (painful bruising syndrome or psychogenic purpura), is a rare disorder first described by Gardner and Diamond in 1955.[1] It typically occurs in middle-aged females with underlying psychiatric disorders such as depression, anxiety or obsessive compulsive disorders. Autosensitization of patients to their own blood, mainly to phosphatidylserine [phosphoglyceride of red blood cell (RBC) membrane] plays an important role in the pathogenesis.[2]

It is characterized by recurrent self-limiting episodes of spontaneously appearing painful ecchymoses, frequently preceded by a prodrome of burning sensation of the skin.[3] There are no specific laboratory findings. An intracutaneous injection of 0.1 ml of autologous washed erythrocytes is a reliable diagnostic test.[2]

A recent hypothesis proposed by researchers of psychoimmunology states the intricacies of the neuroimmunocutaneous endocrine network, which might explain the response of anxiolytics and antidepressants in our case. Sometimes psychotherapy may be beneficial.[4]

Though it is a rare disease, it should be considered in the differential diagnosis of recurrent painful purpura. Prompt diagnosis helps to avoid exhaustive investigations and aggressive treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ivanov OL, Lvov AN, Michenko AV, Künzel J, Mayser P, Gieler U. Autoerythrocytesensitization syndrome (Gardner-Diamond syndrome): Review of the literature. J Eur Acad Dermatol Venereol 2009;23:499-504.  Back to cited text no. 1
    
2.
Tainwala RR, Phiske M, Raghuwanshi A, Mathapati S, Manjare AK, Jerajani HR. Perplexing purpura in two females: Rare case of autoerythrocyte sensitization syndrome. Indian Dermatol Online J 2013;4:305-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
McIntosh RM, Ozawa T, Persoff M, Altshuler JH, Guggenheim S, Boedecker E. Nephropathy associated with Gardner-Diamond syndrome. Autologous erythrocyte antigen-antibody immune-complex disease. N Engl J Med 1977;296:1265-7.  Back to cited text no. 3
    
4.
Sawant NS, Singh DA. Antidepressant-induced Remission of Gardner Diamond Syndrome. Indian J Psychol Med 2012;34'388-90.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Gardner-Diamond syndrome: a systematic review of treatment options for a rare psychodermatological disorder
Megan E. Block,Jenna L. Sitenga,Michael Lehrer,Peter T. Silberstein
International Journal of Dermatology. 2018;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed1107    
    Printed3    
    Emailed0    
    PDF Downloaded167    
    Comments [Add]    
    Cited by others 1    

Recommend this journal