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Autoerythrocyte sensitization in Adult
Other Resources UpToDate PubMed

Autoerythrocyte sensitization in Adult

Contributors: Daniel Yanes MD, Anne Seidler MD, MBA, Susan Burgin MD
Other Resources UpToDate PubMed


Autoerythrocyte sensitization, also known as Gardner-Diamond syndrome or psychogenic purpura, was initially described by Gardner and Diamond in 1955 as an abnormal response to bruising. The designation "autoerythrocyte sensitization" is from this and other early reports that patients seemed to react to an intradermal injection of their own erythrocytes. However, later reports were not able to confirm this finding consistently.

The disorder is characterized by bruising without clear precipitating causes or definite trauma. Women are most frequently affected. The painful bruises vary in size and may have peculiar or geometric shapes. Bruising is most commonly seen on the lower extremities, but other sites of involvement have been reported. Associated symptoms include abdominal pain, nausea, vomiting, diarrhea, and headache. Prodromal symptoms such as pain, warmth, or itching at the site prior to the bruising have been described. The bruises resolve in approximately 2 weeks but recur.

The etiology of autoerythrocyte sensitization is unknown. Reported associations include the presence of a psychiatric disorder (including depression, borderline personality disorder, obsessive-compulsive disorder, and anxiety), a preceding traumatic event (such as a procedure or surgery up to 2 years prior to the onset of symptoms), or severe psychosocial stress (such as marital conflicts, or death or illness of a family member).


D69.2 – Other nonthrombocytopenic purpura

275446004 – Gardner-Diamond syndrome

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Differential Diagnosis & Pitfalls

  • Traumatic purpura – Bruises can be explained by a known physical force.
  • Solar purpura – Aged, thin skin, especially on forearms.
  • Drug-induced non-palpable purpura (NSAIDs, clopidogrel, heparin, warfarin, or steroid atrophy)
  • Hepatic insufficiency with poor synthetic function
  • Vitamin K deficiency – Malabsorption, poor diet (eg, alcohol use disorder), or drugs that bind the vitamin (eg, cholestyramine).
  • Disseminated intravascular coagulation
  • Consider possibility of Adult physical abuse; the differential diagnosis in children aged 9-12 years includes Bruise of child abuse.
  • Pigmented purpura (see Capillaritis) – Yellow-brown patches with superimposed petechiae.
  • Hyperglobulinemic purpura of Waldenström – Recurrent purpura preceded by mild itching, tingling, or burning, often associated with tight-fitting clothing, heat, or prolonged standing; associated with polyclonal hypergammaglobulinemia of IgG or IgA rheumatoid factor; Sjögren syndrome may develop in some patients.
  • Clotting or platelet disorders – Personal and/or family history may be suggestive.
  • Leukemia – Abnormal CBC or peripheral smear.
  • Vasculitis or Cryoglobulinemia – Palpable purpura.
  • Scurvy / vitamin C deficiency – Dietary history; perifollicular.
  • Ehlers-Danlos syndrome, or connective tissue diseases – Skin hyperextensibility; joint hypermobility; joint dislocations / atrophic scars.
  • Acute meningococcemia
  • Bacterial sepsis
  • AL amyloidosis

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Last Reviewed:12/12/2019
Last Updated:01/26/2020
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Autoerythrocyte sensitization in Adult
A medical illustration showing key findings of Autoerythrocyte sensitization : Abdominal pain, Diarrhea, Headache, Nausea, Emotional stress or trauma, Painful skin lesions, Ecchymosis, Recurring episodes
Clinical image of Autoerythrocyte sensitization - imageId=546204. Click to open in gallery.  caption: 'A large ecchymotic plaque on the leg.'
A large ecchymotic plaque on the leg.
Copyright © 2024 VisualDx®. All rights reserved.