CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1625126
This article is part of the Research TopicAdvances in skin immunologyView all 12 articles
Case report: Psychogenic Purpura in a Uremic Patient on Peritoneal Dialysis
Provisionally accepted
Lin Zhang
Hanqing Zhang
Yuetong ZhaoTao ZhangZhengjie Zhu
Yanheng QiaoYongming TianHang SuJie Li*
Bo Yang*- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Psychogenic purpura (Gardner-Diamond syndrome) is a rare autoimmune vasculopathy characterized by the spontaneous onset of painful edema and infiltrative cutaneous lesions that rapidly develop into ecchymosis after severe psychological stress events. In this article, we report an 87-year-old female uremic patient who was admitted to the hospital with erythema and subcutaneous ecchymoses on the head and face following an Aedes mosquito sting. She was previously diagnosed with "toxic insect stings and skin bacterial infections" and was given anti-infective treatment by an outside hospital, which was ineffective. Subsequent laboratory tests at our hospital revealed only an increase in fibrinogen and leukocytosis. Tracing the history revealed that the patient's purpura episodes were related to a major life event, the death of her husband. After consultation with the dermatology department, the patient's autoerythrocyte sensitization test was positive, and she was finally diagnosed with "psychogenic purpura". Treatment included glucocorticoids and immunomodulators, supplemented by anti-infective and renal replacement therapy, and the patient's ecchymosis gradually subsided and resolved after one month of follow-up. This case highlights the complexity of diagnosing psychogenic purpura and the significance of medical history in the diagnosis. Only accurate and timely diagnosis can effectively avoid unnecessary treatment.
Keywords: Psychogenic purpura, Gardner-Diamond syndrome, Autoerythrocyte sensitization syndrome, Uremia, Autoimmunity, differential diagnosis
Received: 08 May 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Zhang, Zhang, Zhao, Zhang, Zhu, Qiao, Tian, Su, Li and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jie Li, Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
Bo Yang, Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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