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Introduction
Autoerythrocyte sensitization syndrome (AES) was first described by Gardner and Diamond [1] in 1955, when four women with painful bruising were depicted. Patients with AES typically present with the development of recurrent, spontaneous, painful ecchymosis, frequently preceded by a prodrome of pain or itching of the skin. Over 100 cases have been reported since then [2], and nearly all cases were in women [3, 4]. The patients are sensitive to their own red blood cells injected intradermally, and underlying coagulopathies are thought to be absent. Psychophysiologic complaints are so frequent that AES has also been referred to as psychogenic purpura. Here, the authors described a 50-year-old woman with AES with a history of general chronic neurodermatitis recently studied in the authors’ institution, who was subjected to extensive investigations over a period of 6 months before the final diagnosis.
Case Report
The 50-year-old woman had recurrent episodes of painful bruising over the neck, thorax, abdomen, lumbus, and the four extremities for 8 months, whilst the scalp, face, nucha, back, and buttocks were not affected (Fig. 1). The patient complained that the bruises appeared spontaneously and were not associated with any inducement, but were accompanied by a gradual increase in pain for approximately 2 days. The patient had a 2-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. Nonetheless, the patient did not frequently use topical or systemic corticosteroids for fear of potential side effects. A detailed inquiry revealed that prick-acupuncture management was usually performed by the patient to relieve the pruritus since 9 months prior to the study when the penultimate episode of neurodermatitis initially broke out.
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Fig. 1
A 50-year-old woman with recurrent ecchymosis over the neck, thorax, abdomen, lumbus, and the four extremities (a), while the scalp, face, nucha, back, and buttocks were unaffected (b). Erythra of chronic neurodermatitis can also been seen following the same distribution
Physical examination at the time of bruising revealed...