001168 - Intradermal testing beyond allergy diagnosis: Insights into Gardner-Diamond Syndrome
Case report
Introduction
Gardner-Diamond Syndrome is an idiopathic psychodermatological condition characterized by recurrent painful purpura triggered by psychological stress, predominantly affecting young women. Diagnosis is established through detailed history, painful cutaneous manifestations progressing to hematomas within 24 hours, and positive intradermal test with 80% washed autologous erythrocytes. No alterations in coagulation parameters or specific histological changes are observed.
Clinical Case
A 38-year-old woman with a significant history of endometriosis, premature deliveries associated with placental abruption and hematomas, allergic rhinoconjunctivitis, and bronchial asthma. Hospitalized for idiopathic mastitis and spontaneous hematomas with suspected immune-inflammatory etiology. Post-discharge, on oral prednisone, she experiences recurrence of painful nodules, hematomas and fever upon dose reduction. Physical examination reveals the appearance of hematomas, documented during physical activity, unrelated to increased emotional stress, preceded by fever and painful inflammatory nodules in the hematoma area. Informed consent is obtained from the patient in question to publish this information.
Diagnostic Methods
- Breast cytology and contrast-enhanced MRI: BIRAD-3 characteristics with no significant findings.
- Ultrasound and core needle biopsy in the right breast: fibrous stroma with no significant alterations.
- Skin biopsy: hematic extravasation without vasculitis or histological signs favoring lupus erythematosus or granulomatous inflammatory process.
- Hemogram, coagulation and autoimmunity tests (ANA, ENA, antiphospholipid, and rheumatoid factor): normal.
- Intradermal test with washed autologous erythrocytes 0,1 and 0,5ml: positive, with ecchymosis at 30 minutes and a hematoma exceeding the puncture area at 24 hours. Control with 0,1ml and 0,5ml physiological saline: negative.
Conclusion
Comprehensive diagnosis and intradermal tests confirm Gardner-Diamond Syndrome, guiding pharmacological treatment to address the psych-dermatological symptoms of the patient.
