Auto-erythrocyte sensitisation syndrome– an unusual cause of bruising

Abstract

Autoerythrocyte sensitisation syndrome or Diamond-Gardner syndrome is a rare disorder characterised by painful and spontaneous purpura occurring in women with mental health problems. It should be considered in the differential diagnosis of spontaneous, painful bruising, especially in patients with mental health problems. Awareness of this condition may prevent unnecessary investigations and allow early referral to psychiatry or psychology. We present the case of a 45-year-old woman who was referred to our haematology clinic with a history of recurrent episodes of spontaneous painful bruising. She had already attended rheumatologists and dermatologists and was proving to be a diagnostic dilemma. Extensive investigations, including full blood count, coagulation screen, factor VIII complex and connective tissue screen, were normal. An autoerythrocyte sensitisation test resulted in the appearance of a bruise preceded by tingling and a stinging sensation similar to her usual symptoms. Although not mentioned in the referral letter and not elicited at the initial consultation, on further questioning a history of psychiatric morbidity was obtained. Having established the likely diagnosis, the patient was agreeable to referral for psychiatric support.