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GARDNER-DIAMOND SYNDROME Medicine Morning Report Seuli Bose Brill, MD 3/1/10.

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Presentation on theme: "GARDNER-DIAMOND SYNDROME Medicine Morning Report Seuli Bose Brill, MD 3/1/10."— Presentation transcript:

1 GARDNER-DIAMOND SYNDROME Medicine Morning Report Seuli Bose Brill, MD 3/1/10

2 Background  Described in 1955 by Frank Gardner and Louis Diamond.  Original case report described painful ecchymoses in 4 female patients.  Other names include:  Psychogenic purpura  Autoerythrocyte sensitization  Painful bruising syndrome  About 120 cases described in literature to date.

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4 Presentation  Unexplained painful ecchymotic lesions.  Involves extremities or the face.  Caucasian women.  Precipitated by emotional stress.  Spontaneous bruising after trauma or surgery.  May occur after a serious emotional disturbance.  Affected individual generally with psychiatric comorbidities.

5 Pathophysiology  Stress induced  Increased levels of endogenous glucocorticoids alters hemostasis.  Increased fibrinolysis  Increased cutaneous activity of tissue plasminogen activator.  Autoerythrocyte sensitization  Autosensitization to phosphoglyceride on RBC membrane.

6 Diagnosis  Clinical.  Laboratory tests generally negative.  PT, PTT, platelet count, platelet function analyzer (PFA-100), anti-phospholipid antibodies, Von Willebrand’s panel, ANA, ESR, CRP.  Auto-erythrocyte sensitization test not useful.  Not standardized or commercially available.  Histopathological exam not necessary.

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8 Differential Diagnosis  Malingering and factitious disorders  Von Willebrand’s disease  Vitamin C deficiency  Small vessel vasculitis  Anti-phospholipid syndrome  Drugs  Ecstasy use  ASA, NSAIDS  SSRIs  Systemic glucocorticoids  Ehlers-Danlos  Hereditary hemorrhagic telangiectasia  Henoch-Schonlein purpura

9 Treatment  Plasmapheresis  No clinical trials  Case report in which plasmapheresis vs. placebo offered to patient who was blinded to therapy.  Pain control  Amitryptyline  Promethazine  Treatment of underlying psychiatric disorder

10 When to consider Gardner Diamond:  Recurrent ecchymoses with painful prodrome.  Normal laboratory evaluation for bleeding diatheses.  Comorbid psychiatric condition.

11 References  Bostwick JM, Imig MW. Gardner-Diamond Syndrome: bruising feeling. Mayo Clin Proc May;83(5):572.Gardner-Diamond Syndrome: bruising feeling.  Gardner, F. and Diamond, L. Autoerythrocyte sensitization, A Form of Purpura Producing Painful Bruising Following Autosensitization to Red Blood Cells in Certain Women. Blood (7):  Giesler, B and Dezube, B. Psychogenic Purpura (Gardner-Diamond Syndrome). UpTo Date. April 15,2009.  Hamblin, T, Hart, S, Mufti, GJ. Plasmapheresis and a placebo procedure in autoerythrocyte sensitization. British Medical Journal Dec: 283:  Ivanov OL, Lvov AN, Michenko AV, Künzel J, Mayser P, Gieler U. Autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome): review of the literature. J Eur Acad Dermatol Venereol May;23(5): Autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome): review of the literature.  Meeder R, Bannister S. Gardner-Diamond syndrome: Difficulties in the management of patients with unexplained medical symptoms. Paediatr Child Health Sep;11(7):416-9.Gardner-Diamond syndrome: Difficulties in the management of patients with unexplained medical symptoms.  Uthman IW, Moukarbel GV, Salman SM, Salem ZM, Taher AT, Khalil IM. Autoerythrocyte sensitization (Gardner-Diamond) syndrome. Eur J Haematol Aug;65(2):144-7.Autoerythrocyte sensitization (Gardner-Diamond) syndrome.

12 Happy Birthday, Alan!


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