Downloaded from http://journals.lww.com/practicalpsychiatry by BhDMf5ePHKbH4TTImqenVEHVxlGnW95UJGHUIixLQgZs06x+57wzpz1WWCnXkv6Z on 01/29/2019 Clinical Case Discussion Gardner-Diamond Syndrome in an Adolescent With Suicidal Ideation: A Case Report Gardner-Diamond syndrome (GDS) is a rare disease often seen in young women involving painful localized inflammation and ecchymosis. Ecchymosis usually develops spontaneously after emotional stress. The pathophysiology of the disease is not fully understood, and little is known about management modalities for this syndrome. The primary approach of health professionals in the evaluation of this rare condition should involve identification of cases and investigation of potential accompanying psychiatric pathologies. The case presented here highlights the importance of assessing for GDS and reviews descriptions of GDS in the context of the existing literature. (Journal of Psychiatric Practice 2019;25;54–57) KEY WORDS: psychogenic purpura, Gardner- Diamond syndrome, antidepressant medications, adolescents Section editor’s note: In this issue of the Journal, we present 2 contrasting cases dealing with rare general medical conditions closely related to psychiatric symptoms. Here Kara et al describe a case of Gardner- Diamond Syndrome, or psychogenic purpura. In this case, the underlying cause of psychological distress was only found late in the process, but its identification eventually led to appropriate care with an anti- depressant. In contrast, the case by Patniyot and Patniyot presented elsewhere in this issue (pp. 58–62) involved a course of illness that was at first thought to be psychiatric but ultimately proved to be a fatal prion infection. The long behavioral prodrome may have delayed the correct nonpsychiatric diagnosis, albeit one that was elusive even when suspected. The authors describe clues regarding the atypical nature of the patient’s psychosis that were important in hindsight. As readers, we can take these cases as springboards to examine our own cognitive processes for making a differential diagnosis—both thinking outside the box ourselves, and knowing when to get consultation from another expert, or to search the literature for illumination by others who took the time to describe rare disorders. David A. Kahn, MD The condition of psychogenic purpura is generally known as Gardner-Diamond syndrome (GDS) or autoerythrocyte sensitization syndrome. This rare disease, in the etiology of which psychological history is thought to play a significant role, is most often reported in middle-aged women. The syndrome was first described by Gardner and Diamond in 1955. 1,2 The disease usually develops with painful cutaneous lesions following psychic stress. Onset involves edema with leakage and may progress to ecchymosis during the following 24 hours. Autoimmune vasculopathy with sensitization to a component of the erythrocyte stroma, phosphatidylserine, is thought to be one of the most common causes at examinations of patients with GDS. Callicrein-kinin system disorder, disturbance of fibrin synthesis in the endothelium, and autosensiti- zation to hemoglobin and deoxyribonucleic acids have also been proposed as potentially causal. The patho- logic process is generally limited to cutaneous lesions that are not associated with disturbances in the blood Case presentation: TAYFUN KARA, MD ZEYNEP TOPKARCI, MD ZÜLFIKAR GÖRDÜ, MD I ˙ SMAIL AKALTUN, MD KARA: Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; TOP- KARCI: Department of Dermatology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; GÖRDÜ: Department of Pediatric Hematology and Oncology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; AKALTUN: Department of Child and Adolescent Psychiatry, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. The authors declare no conflicts of interest. Please send correspondence to: Tayfun Kara, MD, Depart- ment of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Bakirkoy 34147, Istanbul, Turkey (e-mail: tayfunkara@hotmail.com). DOI: 10.1097/PRA.0000000000000351 54 January 2019 Journal of Psychiatric Practice Vol. 25, No. 1 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.