Images in hematology: Psychogenic purpura

✍ Scribed by Moll, Stephan

• Book ID: 101214396
• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 173 KB
• Volume: 55
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/(sici)1096-8652(199707)55:3<146::aid-ajh5>3.0.co;2-s

✦ Synopsis

A 48-year-old woman with no previous bleeding problems presented with a 1-year history of spontaneous skin bruising. Her bruises always developed in a typical pattern: Without antecedent event, she would experience a sudden localized ''stinging, popping, and pulsating'' sensation in her skin over the extremities or trunk. The surrounding skin would feel very warm, turn diffusely red, and itch intensely. Within minutes, a bruise would appear and enlarge over 20-30 mins. The associated symptoms would subside after approximately 2 hr, after which the patient would feel extremely exhausted. The bruises would disappear after several weeks.

The patient had multiple emotional stresses, including localized breast cancer diagnosed 2 years before onset of the bruising (free of disease after treatment), a pending medical law suit, loss of a job held for more than 20 years, and significant marital problems with a pending law suit for divorce. She saw a psychiatrist and was treated for depression. There was no evidence of domestic physical violence. Physical examination was unremarkable, except for the illustrated skin findings. Image A shows a ''bruise''