26-year-old French Caucasian woman, with a recent depression diagnosis, presented herself in our Emergency-Room with one-week history of recurrent bruising, aggravating a few days after traveling to Portugal, associating with general-malaise and fatigue.
Skin lesions were evident in upper and lower limbs (Fig. 1), ranging from painful skin indurations, edematous plaques, and ecchymosis (pointed out with arrows).
There was no family or personal history of bleeding disorders or nonsteroidal anti-inflammatory-drugs use. Laboratory tests (complete blood count, coagulation profile, autoimmunity, among others) were normal.
Psychogenic purpura (PP) was considered, and psychiatric treatment initiated, with disappearance of skin lesions and no recurrence for a 4-month period.
PP or Gardner-Diamond syndrome is a rare condition, regarded primarily as an autoimmune vasculopathy with phosphatidylserine (erythrocyte-stroma component) sensitization; characterized by spontaneous development of painful edematous skin lesions that develop into ecchymosis within 24 h.
Diagnosis is done mainly in women, following severe stress or emotional trauma.
In patients with unexplained recurrent ecchymosis, PP should be considered as exclusion diagnosis. No confirmatory test (blood test or histopathologic) or specific treatment exists.
The medical knowledge of this entity can reduce the performance of invasive tests.
Therapy with psychotropic drugs and psychotherapy are considered methods of treatment and should be provided together with symptomatic therapy.
Conflicts of interestThe authors declare that there is no conflict of interest in this work.
Funding sourcesThe authors declare that there were no external sources of study for the performance of this article.
Right to privacy and informed consentThe authors declare that no data that allows identification of the patient appears in this article.
