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Gardner-Diamond Syndrome. Medicine Morning Report Seuli Bose Brill, MD 3/1/10. Background. Described in 1955 by Frank Gardner and Louis Diamond. Original case report described painful ecchymoses in 4 female patients. Other names include: Psychogenic purpura Autoerythrocyte sensitization

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Gardner diamond syndrome

Gardner-Diamond Syndrome

Medicine Morning Report

Seuli Bose Brill, MD

3/1/10


Background
Background

  • Described in 1955 by Frank Gardner and Louis Diamond.

  • Original case report described painful ecchymoses in 4 female patients.

  • Other names include:

    • Psychogenic purpura

    • Autoerythrocyte sensitization

    • Painful bruising syndrome

  • About 120 cases described in literature to date.


Presentation
Presentation

  • Unexplained painful ecchymotic lesions.

  • Involves extremities or the face.

  • Caucasian women.

  • Precipitated by emotional stress.

    • Spontaneous bruising after trauma or surgery.

    • May occur after a serious emotional disturbance.

  • Affected individual generally with psychiatric comorbidities.


Pathophysiology
Pathophysiology

  • Stress induced

    • Increased levels of endogenous glucocorticoids alters hemostasis.

  • Increased fibrinolysis

    • Increased cutaneous activity of tissue plasminogen activator.

  • Autoerythrocyte sensitization

    • Autosensitization to phosphoglyceride on RBC membrane.


Diagnosis
Diagnosis

  • Clinical.

  • Laboratory tests generally negative.

  • PT, PTT, platelet count, platelet function analyzer (PFA-100), anti-phospholipid antibodies, Von Willebrand’s panel, ANA, ESR, CRP.

  • Auto-erythrocyte sensitization test not useful.

    • Not standardized or commercially available.

  • Histopathological exam not necessary.


Differential diagnosis
Differential Diagnosis

  • Malingering and factitious disorders

  • Von Willebrand’s disease

  • Vitamin C deficiency

  • Small vessel vasculitis

  • Anti-phospholipid syndrome

  • Drugs

    • Ecstasy use

    • ASA, NSAIDS

    • SSRIs

    • Systemic glucocorticoids

  • Ehlers-Danlos

  • Hereditary hemorrhagic telangiectasia

  • Henoch-Schonlein purpura


Treatment
Treatment

  • Plasmapheresis

    • No clinical trials

    • Case report in which plasmapheresis vs. placebo offered to patient who was blinded to therapy.

  • Pain control

    • Amitryptyline

    • Promethazine

  • Treatment of underlying psychiatric disorder


When to consider gardner diamond
When to consider Gardner Diamond:

  • Recurrent ecchymoses with painful prodrome.

  • Normal laboratory evaluation for bleeding diatheses.

  • Comorbid psychiatric condition.


References
References

  • Bostwick JM, Imig MW. Gardner-Diamond Syndrome: bruising feeling. Mayo Clin Proc. 2008 May;83(5):572.

  • Gardner, F. and Diamond, L. Autoerythrocyte sensitization, A Form of Purpura Producing Painful Bruising Following Autosensitization to Red Blood Cells in Certain Women. Blood. 1955. 10(7): 1955-1971.

  • Giesler, B and Dezube, B. Psychogenic Purpura (Gardner-Diamond Syndrome). UpTo Date. April 15,2009.

  • Hamblin, T, Hart, S, Mufti, GJ. Plasmapheresis and a placebo procedure in autoerythrocyte sensitization. British Medical Journal. 1981 Dec: 283: 1575-1576.

  • Ivanov OL, Lvov AN, Michenko AV, Künzel J, Mayser P, Gieler U. Autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome): review of the literature. J Eur Acad Dermatol Venereol. 2009 May;23(5):499-504.

  • Meeder R, Bannister S. Gardner-Diamond syndrome: Difficulties in the management of patients with unexplained medical symptoms. Paediatr Child Health. 2006 Sep;11(7):416-9.

  • Uthman IW, Moukarbel GV, Salman SM, Salem ZM, Taher AT, Khalil IM. Autoerythrocyte sensitization (Gardner-Diamond) syndrome. Eur J Haematol. 2000 Aug;65(2):144-7.