Archer-Dubon C, Orozco-Topete R, Reyes-Gutierrez E
Department of Dermatology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
Rev Invest Clin. 1998 Mar-Apr;50(2):145-8.
Psychogenic purpura, also known as recurrent painful bruising or autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome) is usually associated with emotionally disturbed patients. It is a troublesome entity for both patient and physician since extensive work-ups yield no diagnosis. We describe two females in their early twenties with recurrent painful bruising and diverse accompanying symptoms which appeared after physical trauma. One of the patients developed a bruise after intradermal injection of her own blood (with no reaction to saline injection). One patient had a personality (borderline) disorder, the other a factitious disorder. Punch biopsies revealed a perivascular inflammatory infiltrate, erythrocyte extravasation and no vasculitis. Psychogenic hemorrhagic disorders are uncommon yet must be considered in the differential diagnosis of purpura. Patients are usually young emotionally troubled females who present painful recurrent bruises on extremities frequently after trauma or surgery. Autoimmune mechanisms and increased cutaneous fibrinolytic activity have been implicated, although further studies are needed. Correct diagnosis is important to avoid aggressive and even mutilating treatments, and an adequate comprehension of these purpuras is important for the attending physician.
精神性紫癜，也称为复发性疼痛性瘀斑或自身红细胞致敏综合征（加德纳 - 戴蒙德综合征），通常与情绪紊乱的患者有关。对于患者和医生来说，这都是一个棘手的问题，因为广泛的检查无法得出诊断结果。我们描述了两名二十出头的女性，她们有复发性疼痛性瘀斑以及身体创伤后出现的各种伴随症状。其中一名患者在皮内注射自己的血液后出现瘀斑（对注射生理盐水无反应）。一名患者患有人格（边缘型）障碍，另一名患有做作性障碍。打孔活检显示血管周围有炎症浸润、红细胞外渗且无血管炎。精神性出血性疾病并不常见，但在紫癜的鉴别诊断中必须予以考虑。患者通常是年轻且情绪困扰的女性，常在创伤或手术后频繁出现四肢疼痛性复发性瘀斑。虽然还需要进一步研究，但自身免疫机制和皮肤纤维蛋白溶解活性增加已被牵连。正确的诊断对于避免激进甚至致残性治疗很重要，而对这些紫癜有充分的理解对于主治医生很重要。
