Gardner-Diamond Syndrome: Bruising Feeling

Abstract

A 53-year-old woman was admitted to the hospital with an atraumatic shoulder ecchymosis that was causing intense pain. Stressors included her significant other's recent diagnosis of cancer and conflict with an adult daughter she described as belittling and demanding. Rather than depressed, the patient seemed dramatic and impressionistic in her style. Her shoulder lesion was ascribed to Gardner-Diamond Syndrome (GDS), a rare blood dyscrasia associated with psychosocial stress, first diagnosed in this patient 10 years earlier. Also known as autoerythrocyte sensitization syndrome or psychogenic purpura, GDS typically presents in females as recurrent spontaneous painful bruising over any body surface. Simultaneous complaints range from headaches and gastrointestinal tract complaints to arthralgias and paresthesias.1Ratnoff OD Psychogenic purpura (authoerythrocyte sensitization): an unsolved dilemma.Am J Med. 1989; 87: 16N-21NPubMed Google Scholar Both physiologic and psychological etiologies have been suggested. Gardner and Diamond2Gardner FM Diamond LK Autoerythrocyte sensitization: a form of purpura producing painful bruising following autosensitization to red blood cells in certain women.Blood. 1955; 10: 675-690PubMed Google Scholar attributed lesions to autoimmune hypersensitivity induced by extravasated red blood cells. Agle and Ratnoff3Agle DP Ratnoff OD Purpura as a psychosomatic entity: a psychiatric study of autoerythrocyte sensitization.Arch Intern Med. 1962 Jun; 109: 685-694Crossref PubMed Scopus (30) Google Scholar described prominent features of conversion disorder and histrionic personality disorder, as well as sadomasochistic relationships, with patients manipulated or frankly abused by significant others. Abnormal fibrin degradation and platelet dysfunction have been proposed as underlying stress-related bruising tendencies.4Geisler BP Dezube BJ Psychogenic purpura (Gardner-Diamond syndrome). UpToDate Patient Information.http://patients.uptodate.com/topic.asp?file=coagulat/24227Google Scholar, 5Puetz J Fete T Platelet function disorder in Gardner-Diamond syndrome: a case report and review of the literature.J Pediatr Hematol Oncol. 2005; 27: 323-325Crossref PubMed Scopus (17) Google Scholar Stigmas—“wounds” erupting during religious ecstasies in which locations correspond to Jesus Christ's crucifixion injuries—have been linked to GDS.4Geisler BP Dezube BJ Psychogenic purpura (Gardner-Diamond syndrome). UpToDate Patient Information.http://patients.uptodate.com/topic.asp?file=coagulat/24227Google Scholar The inked lines on the photograph show the extent of bruising that appeared on the patient's chest when told of hospital discharge that she considered premature. After physicians relented and granted additional hospital time, the purpura retreated within hours to the small central discoloration within the marked lines. Although the pathophysiology of GDS is elusive, hematologic, dermatological, neurologic, and psychiatric components will likely factor in ultimate explanations.