Per Oral Bleeding: Rare Presentation of Gardner-Diamond Syndrome.

Abstract

A10-year boy presented with spontaneous episodes of oral bleeding for the last 6 months. Detailed ENT examination showed no pathology, bleeding profile was normal, endoscopy and dental examination also did not reveal any abnormality. Child abuse or malingering was also ruled out. Initially the child was managed with platelet transfusion and fresh frozen plasma and then put on follow-up treatment with antifibrinolytics, Vitamin C but the episodes became recurrent. Psychiatric evaluation revealed that child was suffering from depression. Antidepressants were prescribed by the psychiatrist that not only cured the depression with time but also the bleeding episodes which were actually related to child's depression (Gardner-Diamond syndrome or psychogenic purpura). This is a diagnosis by exclusion where the patients bleed due to dysregulated steroid secretion secondary to stress; resulting in development of sensitization to RBC membrane, and dysregulated fibrinolytic system activity.

• Authors: Unaiza Qamar, Nisar Ahmad, Saima Farhan
• Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (J Coll Physicians Surg Pak) Vol. 25 Issue 6 Pg. 465-6 (Jun 2015) ISSN: 1681-7168 [Electronic] Pakistan
• PMID: 26101006 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antidepressive Agents, Tricyclic
• Nortriptyline

Topics

• Antidepressive Agents, Tricyclic (therapeutic use)
• Autoimmune Diseases (diagnosis, drug therapy)
• Child
• Factitious Disorders (diagnosis, drug therapy)
• Hemorrhage (etiology, psychology)
• Humans
• Male
• Nortriptyline (therapeutic use)
• Psychophysiologic Disorders (drug therapy, etiology)
• Psychotic Disorders (diagnosis, drug therapy)
• Skin Diseases, Vascular (diagnosis, drug therapy)
• Treatment Outcome