Autoerythrocyte sensitization syndrome presenting with general neurodermatitis
A 70-year-old woman had recurrent episodes of painful bruising on the back, abdomen, and four extremities for 5 years (). The patient complained that the bruises appeared after scratching the skin to relieve pruritus. The patient had a 5-year history of general chronic neurodermatitis without any bleeding manifestations, such as melena, hematuria, and menorrhagia. The neurodermatitis had usually recurred approximately every 4-6 months with severe itching over the lesions, and the last relapse was approximately 3 months prior to the study. Symptoms of itching could be relieved by oral antihistamines or corticosteroids; however, the ecchymosis was unaffected.\nPhysical examination at the time of bruising revealed scattered ecchymosis with lesions varying in size. The lesions were tender, without bleeding, ulceration, or scarring. Dispersive, noticeable excoriation could be seen on the same regions especially on the trunk. Laboratory tests showed normal values for complete blood cell count, platelet count and coagulation panels. There were no detectable autoimmune abnormalities that would explain the lesions. Punch biopsies of the skin lesions revealed scant superficial perivenular lymphocytic infiltration.\nAn intradermal test for autoerythrocyte sensitization was performed, with 0.1 mL of the patient's washed red blood cells, whole blood, plasma, and normal saline injected in an inaccessible area of the back, lateral to thoracic spine. Approximately 24 hours later, the patient developed a painful ecchymotic reaction on the washed red blood cell (RBC) and whole blood injection site, while no reaction was observed on the plasma and normal saline injection site ().\nPsychiatric evaluation of the patient revealed depression with anxiety features. The patient was empirically given oral antihistamines, steroids and anxiolytics. The ecchymosis reduced and finally diminished approximately 4 weeks later, with a follow-up of stationary phase for more than 3 months.