Indian Dermatology Online Journal

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

Gardner diamond syndrome: A psychogenic purpura


K Vivekanandh, Gaurav Dash, Prasenjeet Mohanty 
 Department of Skin & VD, SCBMCH, Cuttack, Odisha, India

Correspondence Address:
K Vivekanandh
Room no. 201, Metro Manorama Complex, Kathagola Road, Mangalabag, Cuttack, Odisha - 753 001
India




How to cite this article:
Vivekanandh K, Dash G, Mohanty P. Gardner diamond syndrome: A psychogenic purpura.Indian Dermatol Online J 2017;8:521-522


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 2020 Feb 23 ];8:521-522
Available from: http://www.idoj.in/text.asp?2017/8/6/521/218337


Full Text



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}{Figure 2}

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

1Ivanov 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.
2Tainwala 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.
3McIntosh 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.
4Sawant NS, Singh DA. Antidepressant-induced Remission of Gardner Diamond Syndrome. Indian J Psychol Med 2012;34'388-90.