Auto-erythrocyte sensitisation syndrome – an unusual cause of bruising

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.