Oropharyngeal psychogenic purpura

Abstract

A 57-year-old woman, who was known to suffer from psychogenic purpura, presented with acute onset dysphagia and purpura of the anterior neck and oropharynx. Psychogenic purpura, also known as Gardner–Diamond syndrome, is a rare condition in which painful, ecchymotic lesions appear, typically on the extremities, following acute emotional stress without any clear traumatic or haematological aetiology. The patient’s lesions had begun with a faint neck bruise followed by swelling and pain with rapid progression, within 3 days, to dysphagia, odynophagia and dyspnoea (top). Given concern for potential worsening and impending respiratory compromise she was hospitalised for close airway monitoring. There were no abnormalities on haematological testing. A psychiatry consultation was arranged to assist with acute anxiety management. Over the next 3 days, her symptoms and abnormal physical findings improved until she could swallow her secretions without difficulty or pain; initial purpura of the posterior oropharynx and right aryepiglottic fold (bottom left and centre) had resolved by 13 days (bottom right). The patient will start psychotherapy to improve emotional regulation.