tag:blogger.com,1999:blog-9870114.post2713896050877539504..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: 17 Year-old Girl with Unexplained BruisingHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-9870114.post-75068057961158854032018-12-11T20:31:10.732+00:002018-12-11T20:31:10.732+00:00from A.R. Pito, Norfolk Island: When I was in pra...from A.R. Pito, Norfolk Island: When I was in practice in Melbourne I saw an occasional case that was similar. These are patients with multiple somatic symptoms. Most of their complaints remain "medically unexplained." This suggests a functional somatic illness. Rheumatologic disease and bleeding diathesis needs to be ruled out; but a careful and sensitive psychiatric evaluation must to be performed. The prognosis for these young people is better than for older individuals. They may be reluctant to discuss personal issues, and their reticence should be respected.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-80682296438998196542018-12-11T20:16:48.942+00:002018-12-11T20:16:48.942+00:00From Dato Cheng Leng, Malaysia: Instead of GDS, I ...From Dato Cheng Leng, Malaysia: Instead of GDS, I would think of a more common condition in a young lady, like a connective tissue disease, especially Systemic Lupus Erythematosis which can be associated with antiphospholipid syndrome and or, leukocytoclastic vasculitis, which causes her bruising.<br />The nausea and vomiting signifies the underlying systemic disease rather than innocent bruising.<br />Her pelvic pain may be due to intermittent thrombosis of the iliac veins, possibly associated with her ‘lazy bladder’.<br /><br />Please add the following which I’ve forgotten at 2:30 am in the early morning:-<br /><br />1. The irregular and excessive menstrual flow can be explained by antiphospholipid syndrome.<br /><br />2. Leucocytoclastic vasculitic bruises are typically tender.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-3711524307324085402018-12-11T20:12:13.614+00:002018-12-11T20:12:13.614+00:00Richard Sontheimer, Salt Lake City: Interesting c...Richard Sontheimer, Salt Lake City: Interesting case. Except for the absence of overt psychological/psychiatric problems which a high percentage of such patients display, this clinical context would be consistent with the Gardner-Diamond syndrome except for the gynecologic and bladder problems. The recent Mayo Clinic series reported a positive “autoerythrocyte sensitization test” in less than half of patients meeting the other clinical criteria for the Gardner-Diamond syndrome. The current recommendations concerning management of Gardner-Diamond syndrome include a complete psychiatric evaluation and any such needed treatment. Treatment of any underlying mental health issues can help mitigate the painful bruising.<br /><br /> <br /><br />The other thing that came to mind in this case of cyclic ecchymosis/bruising was cyclical thrombocytopenia. Has this girl's platelet count been checked during her menses which is the time point at which the platelet count is typically lowest in this curious hematologic condition? Cyclical thrombocytopenia could explain one component of this girl’s gynecologic history, menometrothagia.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-4762180924428712332018-12-11T20:10:34.055+00:002018-12-11T20:10:34.055+00:00From Professor Sharquiek Baghdad: The spontaneous ...From Professor Sharquiek Baghdad: The spontaneous ecchymosis is not a rare skin problem seen among females without any other obvious complaints .It is usually recurrent over a period of time and then disappear and rarely severe ecchymosis.The auto erythrocytes sensitization theory should not be accepted easily as inflammatory reaction always precede ecchymosis.Accordingly there should be inflammation first that cause rupture of blood vessels then followed by ecchymosis???<br />So the etiology till now could not be explained by the auto erythrocytes sensitization as such? Further thoughts might be helpful Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-76213669456570308242018-12-11T20:09:01.998+00:002018-12-11T20:09:01.998+00:00From Brian Maurer, Connecticut: In general terms o...From Brian Maurer, Connecticut: In general terms one thinks about some sort of coagulopathy or recurrent vasculitis. That would certainly tie in with the menorrhagia and pelvic pain. Although the previous hematologic work up was reportedly negative, I would consider von Willibrand’s high on the list. There are any number of subtypes with varying degrees of expression. Another separate diagnosis apropos the pelvic pain and menstrual issues might be endometriosis.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.com