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  Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 12  |  Issue : 5  |  Page : 774-775  

Achenbach syndrome: A rare case of paroxysmal finger hematoma


Department of Dermatology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India

Date of Submission21-Nov-2020
Date of Decision06-Mar-2021
Date of Acceptance15-Apr-2021
Date of Web Publication02-Aug-2021

Correspondence Address:
Chander Grover
Department of Dermatology and STD, UCMS and GTB Hospital, Dilshad Garden, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_822_20

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How to cite this article:
Gaurav V, Grover C. Achenbach syndrome: A rare case of paroxysmal finger hematoma. Indian Dermatol Online J 2021;12:774-5

How to cite this URL:
Gaurav V, Grover C. Achenbach syndrome: A rare case of paroxysmal finger hematoma. Indian Dermatol Online J [serial online] 2021 [cited 2021 Oct 24];12:774-5. Available from: https://www.idoj.in/text.asp?2021/12/5/774/322694



Dear Editor,

Paroxysmal finger hematoma or Achenbach syndrome refers to an acute-onset bluish discoloration involving few fingers usually, although it can involve the palms or dorsum of hands.[1],[2] It may be asymptomatic, but is more commonly associated with paresthesia or pain. Rupture of superficial veins and consequent hemorrhage is often the cause of the signs and symptoms of the disease.[2] The exact etiology is unknown; however, twisting or gripping movement has been commonly associated with the onset of symptoms. We report a case with paroxysmal finger hematoma suggestive of Achenbach syndrome.

A 54-year-old man presented with sudden-onset bluish discoloration noted over the tip of his left middle and ring fingers. It was noticed over both the dorsal and palmar aspects of left hand after trying to fix a screw forcefully and was associated with excruciating pain and paresthesia over the region. The patient denied any previous trauma, was a nonsmoker, and not on any oral drugs including anticoagulants. The patient denied having similar episodes in the past. His past medical and surgical history was insignificant.

On examination, there was distinctive but ill-defined discoloration of the tips of left middle and ring finger noticed on the digital pulp as well as nail beds [Figure 1]a and [Figure 1]b. The digits were exquisitely tender with tenderness extending to the dorsum of left hand accompanied by phlebectasia. All the extremities were warm and all peripheral pulses were palpable and of good volume. A detailed systemic and cutaneous examination revealed no other abnormality. Laboratory investigations showed a normal hematological, biochemical, and coagulation profile and an ultrasound Doppler study of the left upper limb was normal.
Figure 1: Bluish discoloration involving the palmar (a) and dorsal aspects with phlebectasia (b) of the middle and ring finger in a male patient

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Based on the history, clinical examination, and laboratory investigations, a diagnosis of paroxysmal finger hematoma was made and the patient was counselled regarding the self-resolving nature of the disease. The pain and discoloration subsided over the next 1 week with symptomatic treatment (cold compresses and oral ibuprofen 400 mg three times daily).

Paroxysmal finger hematoma/finger apoplexia is also known as Achenbach syndrome after the German physician who first described it.[1] It is a rare disease with very few cases being reported in the literature. It presents as acute-onset bluish discoloration of one or more fingers and/or palms and is most frequently associated with pain followed by edema and paresthesia.[2] A preceding history of trauma can be present in up to 30% of individuals.[2] The acute presentation causes worry and anxiety both in the patient and the caregiver; hence, an awareness about this condition is important to allay fear and avoid unnecessary investigations. Nevertheless, an acute presentation lends this entity to many close differential diagnoses which can usually be excluded clinically. These are summarized in [Table 1], with salient differentiating points. This is important as a diagnosis of Achenbach syndrome is mainly based on clinical assessment. Our patient presented with acute onset bluish discoloration and pain with paresthesia over left middle and ring finger, with phlebectasia over the dorsum of left hand. There was a significant improvement of symptoms and swelling at the end of seven 4 days, even with conservative management, thus confirming the diagnosis.
Table 1: Differential diagnosis of blue finger(s)

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In conclusion, Achenbach syndrome is a rare presentation with paroxysmal bruising of fingers, which may be associated with pain and paresthesias. Spontaneous resolution over days is the rule and hence reassurance and symptomatic management is sufficient in most cases. This report serves to highlight the common differentials to be considered as well as the benign nature of the disease. It will help to raise awareness about this uncommon entity, so as to help avoid unnecessary time consuming and expensive investigations.

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.[9]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Achenbach W. Das paroxysmale Handhämatom. Medizinische 1958;52:2138-40.  Back to cited text no. 1
    
2.
Kordzadeh A, Caine PL, Jonas A, Rhodes KM, Panayiotopolous YP. Is Achenbach's syndrome a surgical emergency? A systematic review. Eur J Trauma Emerg Surg 2016;42:439-43.  Back to cited text no. 2
    
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Ada F, Kasimzade F. Analysis of 24 patients with Achenbach's syndrome. World J Clin Cases 2019;7:1103-10.  Back to cited text no. 3
    
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Olinic DM, Stanek A, Tătaru DA, Homorodean C, Olinic M. Acute limb ischemia: An update on diagnosis and management. J Clin Med 2019;8:1215-26.  Back to cited text no. 4
    
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Olin JW, Shih A. Thromboangiitis obliterans (Buerger's disease). Curr Opin Rheumatol 2006;18:18-24.  Back to cited text no. 5
    
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Baker JS, Miranpuri S. Perniosis a case report with literature review. J Am Podiatr Med Assoc 2016;106:138-40.  Back to cited text no. 6
    
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Temprano KK. A review of Raynaud's disease. Mo Med 2016;113:123-6.  Back to cited text no. 7
    
8.
Das S, Maiti A. Acrocyanosis: An overview. Indian J Dermatol 2013;58:417-20.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Vivekanandh K, Dash G, Mohanty P. Gardner diamond syndrome: A psychogenic purpura. Indian Dermatol Online J 2017;8:521-2.  Back to cited text no. 9
[PUBMED]  [Full text]  


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