Autoerythrocyte sensitization in Child
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
Differential Diagnosis & Pitfalls
- Traumatic purpura – Bruises can be explained by a known physical force.
- Drug-induced purpura – NSAIDs, clopidogrel, heparin, warfarin, or steroid atrophy.
- Hepatic insufficiency with poor synthetic function
- Vitamin K deficiency – Malabsorption, poor diet, or drugs that bind the vitamin (eg, cholestyramine).
- Disseminated intravascular coagulation
- Consider possibility of domestic violence; the differential diagnosis in children aged 9-12 years includes child abuse.
- Pigmented purpura (see capillaritis) – Yellow-brown patches with superimposed petechiae.
- Hypergammaglobulinemic purpura of Waldenstrom – 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's 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
- Systemic amyloidosis