2 CASES OF PSYCHOGENIC PURPURA

Psychogenic purpura, also known as recurrent painful bruising or autoe rythrocyte sensitization syndrome (Gardner-Diamond syndrome) is usuall y associated with emotionally disturbed patients. It is a troublesome entity for both patient and physician since extensive work-ups yield n o diagnosis. We describe two females in their early twenties with recu rrent painful bruising and diverse accompanying symptoms which appeare d after physical trauma. One of the patients developed a bruise after intradermal injection of her own blood (with no reaction to saline inj ection). One patient had a personality (borderline) disorder, the othe r a factitious disorder. Punch biopsies revealed a perivascular inflam matory infiltrate, erythrocyte extravasation and no vasculitis. Psycho genic hemorrhagic disorders are uncommon yet must be considered in the differential diagnosis of purpura. Patients are usually young emotion ally troubled females who present painful recurrent bruises on extremi ties frequently after trauma or surgery. Autoinmune mechanisms and inc reased cutaneous fibrinolytic activity have been implicated, although further studies are needed. Correct diagnosis is important to avoid ag gressive and even mutilating treatments, and an adequate comprehension of these purpuras is important for the attending physician.