PMID- 30879737
OWN - NLM
STAT- MEDLINE
DCOM- 20191212
LR  - 20191217
IS  - 1538-2990 (Electronic)
IS  - 0002-9629 (Linking)
VI  - 357
IP  - 5
DP  - 2019 May
TI  - The Mayo Clinic Experience With Psychogenic Purpura (Gardner-Diamond Syndrome).
PG  - 411-420
LID - S0002-9629(19)30034-5 [pii]
LID - 10.1016/j.amjms.2019.02.002 [doi]
AB  - BACKGROUND: The objective of this study was to describe presentation, natural 
      history, management and long-term outcomes of patients with psychogenic purpura 
      (PP), also known as Gardner-Diamond Syndrome. METHODS: In this retrospective 
      study, records of patients with a diagnosis of PP seen at Mayo Clinic, Rochester 
      from 1976 to 2016 were reviewed. Available literature regarding PP was also 
      comparatively reviewed. RESULTS: Seventy-six patients with a diagnosis of PP were 
      identified and 54/76 (71%) experienced a prodromal sensation. The Condensed 
      MCMDM-1 bleeding score, excluding cutaneous manifestations, was <3 in 91% of 
      patients. Laboratory tests of primary and secondary hemostasis were normal. 
      Fifty-four percent of patients had an underlying psychiatric diagnosis. 
      Management approaches included psychological counseling and psychiatry evaluation 
      in 44 patients. Pharmacologic treatment for 30 patients included psychotropic 
      agents, antihistamines, hormonal medications and anti-inflammatory agents. At a 
      median follow-up of 5years (range 1-34),13/28 (46.4%) experienced recurrent 
      ecchymoses and 6 continued to seek hematology follow-up at Mayo Clinic, 
      Rochester. Our data was similar to the aggregate data from case reports in the 
      literature. CONCLUSIONS: For patients with unexplained recurrent ecchymosis a 
      diagnosis of PP should be considered. Diagnosis is one of exclusion and initial 
      evaluation should include documenting a bleeding score and obtaining laboratory 
      tests assessing primary and secondary hemostasis. The relatively low bleeding 
      scores together with laboratory assessments support that PP is primarily a dermal 
      rather than a systemic bleeding diathesis. In our cohort, addressing 
      psychological stressors was the most effective treatment; however pharmacologic 
      therapy can be used for refractory disease.
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Sridharan, Meera
AU  - Sridharan M
AD  - Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, 
      Minnesota.
FAU - Ali, Uzma
AU  - Ali U
AD  - Minnesota Oncology, Fridley, Minnesota.
FAU - Hook, C Christopher
AU  - Hook CC
AD  - Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, 
      Minnesota.
FAU - Nichols, William L
AU  - Nichols WL
AD  - Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, 
      Minnesota; Division of Hematopathology and Laboratory Genetics, Department of 
      Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
FAU - Pruthi, Rajiv K
AU  - Pruthi RK
AD  - Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, 
      Minnesota; Division of Hematopathology and Laboratory Genetics, Department of 
      Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. Electronic 
      address: pruthi.rajiv@mayo.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20190207
PL  - United States
TA  - Am J Med Sci
JT  - The American journal of the medical sciences
JID - 0370506
RN  - Gardner-Diamond syndrome
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Autoimmune Diseases/*etiology/*therapy
MH  - Cohort Studies
MH  - Factitious Disorders/*etiology/*therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minnesota
MH  - Psychotic Disorders/*etiology/*therapy
MH  - Retrospective Studies
MH  - Skin Diseases, Vascular/*etiology/*therapy
MH  - Young Adult
OTO - NOTNLM
OT  - Autoerythrocyte
OT  - Ecchymosis
OT  - Gardner-Diamond
OT  - Psychogenic
OT  - Purpura
EDAT- 2019/03/19 06:00
MHDA- 2019/12/18 06:00
CRDT- 2019/03/19 06:00
PHST- 2018/06/19 00:00 [received]
PHST- 2019/02/04 00:00 [revised]
PHST- 2019/02/05 00:00 [accepted]
PHST- 2019/03/19 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2019/03/19 06:00 [entrez]
AID - S0002-9629(19)30034-5 [pii]
AID - 10.1016/j.amjms.2019.02.002 [doi]
PST - ppublish
SO  - Am J Med Sci. 2019 May;357(5):411-420. doi: 10.1016/j.amjms.2019.02.002. Epub 
      2019 Feb 7.