Perplexing purpura in two females: Rare case of autoerythrocyte sensitization syndrome
A 19-year-old female presented with recurrent painful bruises over her extremities since 10 days, the first episode being at age of 16 years. Some episodes followed trivial trauma. She experienced a burning sensation at the injured site few minutes after trivial trauma, with subsequent redness and an appearance of painful bruise lasting for several days. She gave no history of bleeding tendencies or any underlying psychiatric illnesses. Cutaneous examination revealed residual ecchymotic irregular patches, 2 cm × 3 cm on the right arm and the legs, non-tender on palpation []. Rest of mucocutaneous, general and systemic examination was normal. Complete hemogram, platelet count, complete coagulation profile and antinuclear antibodies done to rule out other causes of purpuras were within normal limits. Radiological investigations were normal. Intradermal injection of 0.1 ml of autologous blood on flexure aspect of left forearm caused an immediate burning sensation at the injection site followed 2 h later by development of an oval, 2 cm, sharply defined erythematous macule []. Intradermal injection of 0.1 ml of saline used as a control on the same arm caused no reaction. Biopsy revealed presence of perivascular infiltrate of neutrophils extending up to the septae of the subcutaneous fat []. There was distinctive fibroinoid deposition around the blood vessels. In addition, there were dermal and subcutaneous hemorrhages. The clinico pathological correlation pointed to the diagnosis of autoerythrocyte sensitization syndrome. As psychiatric associations are frequent, a detailed psychiatric evaluation was done which revealed mixed anxiety depression disorder. Treatment was initiated with tab. Amytriptyline 10 mg and Lorazepam 0.25 mg ½ tab 3 times a day with no new lesions for a week but recurrence of lesions was noted probably secondary to trivial trauma thereafter.