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LETTERS TO EDITOR  
Year : 2021  |  Volume : 63  |  Issue : 2  |  Page : 208-209
Diamond Gardner syndrome in a male: A case report


1 Department of Psychiatry, Command Hospital (Southern Command), Pune, Maharashtra, India
2 Department of Dermatology, Command Hospital (Southern Command), Pune, Maharashtra, India

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Date of Submission23-Jan-2020
Date of Decision22-Mar-2020
Date of Acceptance20-Apr-2020
Date of Web Publication14-Apr-2021
 

How to cite this article:
Singh R, Sharma R, Pathania V, Khadka B. Diamond Gardner syndrome in a male: A case report. Indian J Psychiatry 2021;63:208-9

How to cite this URL:
Singh R, Sharma R, Pathania V, Khadka B. Diamond Gardner syndrome in a male: A case report. Indian J Psychiatry [serial online] 2021 [cited 2021 May 9];63:208-9. Available from: https://www.indianjpsychiatry.org/text.asp?2021/63/2/208/313715




Sir,

Gardner–Diamond syndrome is a rare autoimmune vasculopathy of little known etiology, which typically occurs in middleaged females; characterized by atraumatic painful ecchymotic lesions following emotional and psychological distress. The condition is characterized by recurrent selflimiting episodes of spontaneously appearing painful ecchymoses.[1],[2] Usually, the investigations including bleeding time, clotting time, capillary fragility, and prothrombin concentration are not contributory. Autosensitization of patients to their own red blood cells, plays an important role in the pathogenesis.[3]

This 32-year-old male industrial worker was referred to Psychiatry OPD by Dermatologist for the evaluation of anxiety symptoms. History revealed premorbidly anxious avoidant and dependent personality traits with free floating anxiety symptoms for past 6 months causing significant distress and dysfunction. Furthermore, there was history of sudden appearance of painful ecchymotic patches over body in stressful, insoluble and conflicting situations [Figure 1]. These patches were self-limiting in nature and used to remit spontaneously in the next 7–10 days. There was no prior history of trauma, bleeding diathesis, any significant drug or family history. Other clinical examination was unremarkable. Serial reviews revealed anxiety cognitions and catastrophization. His hematological and biochemical investigations including platelet size and morphology, coagulation profile and antinuclear antibodies were within normal limits. A hematology and dermatology consult was taken and intradermal injection of 0.1 ml autologous washed erythrocytes on flexure aspect of the left forearm caused an ecchymotic patch of approximately 2 cm diameter in 2 h [Figure 2]. Based on the above findings, he was diagnosed with Diamond–Gardner syndrome and was started on tablet amitryptiline 75 mg and short course of benzodiazepines. After 3 weeks, he was enrolled in psychotherapy in the form of psychoeducation about illness and cognitive behaviour therapy (CBT) for anxiety. During regular monthly follow-up period, there was no re-emergence of such symptoms.
Figure 1: Ill-defied ecchymotic patch of 2–5 cm size over the left thigh

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Figure 2: Positive auto-erythrocyte sensitization test compared to control (normal saline) over the left forearm

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Diamond Gardner syndrome is one of the classical examples of psychocutaneous disorders. It was earlier thought to be exclusively an illness of female as there were very few case reports of male being afflicted by this disease.[4],[5] With increase in number of cases being reported, it should be considered in the differential diagnosis of recurrent painful purpura even in males.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name will not be published and due efforts will be made to conceal his identity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gardner FH, Diamond LK. Autoerythrocyte sensitization; a form of purpura producing painful bruising following autosensitization to red blood cells in certain women. Blood 1955;10:675-90.  Back to cited text no. 1
    
2.
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 2009;23:499-504.  Back to cited text no. 2
    
3.
Karakaş Z, Karaman S, Avcı B, Ünüvar A, Öztürk G, Anak S, et al. A disease difficult to diagnose: Gardner-Diamond syndrome accompanied by platelet dysfunction. Turk Pediatri Ars 2014;49:250-3.  Back to cited text no. 3
    
4.
Tainwala RR, Phiske M, Raghuwanshi A, Mathapati S, Manjare AK, Jerajani HR. Perplexing purpura in two females: Rare case of autoerythrocyte sensitization syndrome. Indian Dermatol Online J 2013;4:305-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Klein RF, Gonen JY, Smith CM. Psychogenic purpura in a man. Psychosom Med 1975;37:41-9.  Back to cited text no. 5
    

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Correspondence Address:
Rachit Sharma
Department of Psychiatry, Command Hospital (Southern Command), Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_41_20

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