A Teenage Girl Who Suddenly Bruises Easily

The Resolution

 

Differential Diagnosis

• Cryoglobulinemia
• Autoerythrocyte sensitization
• Vitamin K deficiency
• Ehlers-Danlos syndrome

 

 

Diagnosis

The correct diagnosis is autoerythrocyte sensitization, also known as Gardner-Diamond syndrome or psychogenic purpura. This disorder is characterized by bruising without clear precipitating causes or definite trauma.

Learnings/What to Look for

• Autoerythrocyte sensitization has been associated with psychiatric illness, sometimes subtle and without initial obvious symptoms
• Bruises are painful, vary in size, and may have peculiar or geometric shapes
• Associated symptoms include abdominal pain, nausea, vomiting, diarrhea, and headache
• Prodromal symptoms such as pain, warmth, or itching at the site prior to the bruising have been described

 

Pearls for Urgent Care Management and Considerations for Transfer

• Diagnosis is by history, physical examination, and laboratory tests to rule out bleeding disorders
• Onset may follow a traumatic event or in the context of severe psychosocial stress. Associated psychiatric abnormalities include depression and anxiety, borderline personality disorder, and obsessive-compulsive disorder
• Once other, physical disorders have been ruled out, referral for psychiatric therapy is warranted