Images in Emergency Medicine
Article Outline
Figure.
Lateral aspect of right thigh with an insidious onset 11 by 5 inch ecchymosis. Used with permission of Lekshmi Vaidyanathan, MBBS, Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
[Ann Emerg Med. 2007;50:108.]
A 52-year-old woman presented to the emergency department (ED) with a rash of insidious onset, with antecedent burning pain on the lateral aspect of her right thigh. The outbreak involved a single extremely painful lesion with a large area of ecchymosis that enlarged to 11×5 inches in less than 24 hours. She had a history of smaller painful rashes and multiple presentations, with no history of trauma, bite, or bleeding disorder. Physical examination and investigation results were negative.
Diagnosis
Gardner-Diamond syndrome
The syndrome was first described by Gardner and Diamond in 1955.1 Subsequently, more than 100 cases have been reported, the largest case series encompassing 71 patients.2 Cause has remained unclear, but prevalence is greater among women with a history of depression or other psychiatric stressors. How this physiologically triggers the response has not been explained. Gardner and Diamond postulated that patients become sensitized to their own RBCs as a result of previous physical injury. Subcutaneous injection of autologous RBCs and hemolysate has reproduced similar local tenderness and induration in a number of cases, suggesting a probable autoimmune cause. In the ED, this is a differential to be considered alongside self-infliction or abuse because the anatomic sites are similar. Recurrent visits are also typical.
Our patient’s stressor was identified as a recent death in the family. The lesion had a classic appearance of being pinkish, with a surrounding violaceous discoloration. The rash faded in a week’s time.
References
PII: S0196-0644(06)02682-5
doi:10.1016/j.annemergmed.2006.12.013
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
