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Spontaneous discoloration of the finger in a 67-year-old woman

Published:November 18, 2020DOI:https://doi.org/10.1016/j.ejim.2020.11.004

      1. Case description

      A 67-year-old woman presented to our clinic because she had developed spontaneous pain and purple discoloration of the fourth finger of her right hand that had started the previous day. She had experienced similar episodes previously, which were not related to cold exposure and had resolved spontaneously. She had no history of trauma and was not taking any medication. On examination, the finger showed mild swelling and a reddish-purple hematoma centered around the proximal interphalangeal joint (Fig. 1). The area was tender and she reported paresthesia. Blood tests showed a normal platelet count and found no abnormalities in the coagulation system.
      Fig 1
      Fig. 1Mild swelling on the fourth finger of the right hand, with a reddish-purple hematoma on the back, centered around the proximal interphalangeal joint. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.).
      What is the diagnosis?
      Diagnosis: Achenbach's syndrome.

      2. Discussion

      Achenbach's syndrome can cause paroxysmal finger hematomas [
      • Kordzadeh A.
      • Caine P.L.
      • Jonas A.
      • Rhodes K.M.
      • Panayiotopolous Y.P.
      Is Achenbach's syndrome a surgical emergency? A systematic review.
      ]. Its etiology is unknown, but its incidence is highest in middle-aged women (2–7 times that in men) [
      • Ada F.
      • Kasimzada F.
      Analysis of 24 patients with Achenbach's syndrome.
      ]. The syndrome most commonly affects the middle and proximal phalangeal regions of the index and middle fingers [
      • Carpentier P.H.
      • Maricq H.R.
      • Biro C.
      • Jiguet M.
      • Seinturier C.
      Paroxysmal finger haematoma–a benign acrosyndrome occurring in middle-aged women.
      ], but can also occur on the palm, wrist, toes, and sole of the foot [
      • Ada F.
      • Kasimzada F.
      Analysis of 24 patients with Achenbach's syndrome.
      ]. The chief complaints are bruising, pain, swelling, and paresthesia [
      • Ada F.
      • Kasimzada F.
      Analysis of 24 patients with Achenbach's syndrome.
      ]. The condition is sometimes recurrent (three times on average) [
      • Ada F.
      • Kasimzada F.
      Analysis of 24 patients with Achenbach's syndrome.
      ]. Spontaneous recovery occurs within 2–14 days (mean duration, 4 days) [
      • Kordzadeh A.
      • Caine P.L.
      • Jonas A.
      • Rhodes K.M.
      • Panayiotopolous Y.P.
      Is Achenbach's syndrome a surgical emergency? A systematic review.
      ], but recovery within several hours has also been reported [
      • Ada F.
      • Kasimzada F.
      Analysis of 24 patients with Achenbach's syndrome.
      ]. Our patient recovered within 7 days without treatment.
      The differential diagnosis includes acute ischemia, Raynaud's syndrome, acrocyanosis, Gardner-Diamond syndrome (psychogenic purpura), and chilblains; however, Achenbach's syndrome can be diagnosed based on a detailed medical history and the physical signs [
      • Kordzadeh A.
      • Caine P.L.
      • Jonas A.
      • Rhodes K.M.
      • Panayiotopolous Y.P.
      Is Achenbach's syndrome a surgical emergency? A systematic review.
      ].
      Clinicians should be familiar with Achenbach's syndrome in order to make a correct diagnosis so that they can reassure patients that it is not a serious condition and treat it conservatively.

      Funding

      None

      Consent

      The patient has provided consent for the publication of this report.

      Declaration of Competing Interest

      None

      Acknowledgment

      None

      References

        • Kordzadeh A.
        • Caine P.L.
        • Jonas A.
        • Rhodes K.M.
        • Panayiotopolous Y.P.
        Is Achenbach's syndrome a surgical emergency? A systematic review.
        Eur J Trauma Emerg Surg. 2016; 42: 439-443https://doi.org/10.1007/s00068-015-0610-0
        • Ada F.
        • Kasimzada F.
        Analysis of 24 patients with Achenbach's syndrome.
        World J Clin Cases. 2019; 7: 1103-1110https://doi.org/10.12998/wjcc.v7.i10.1103
        • Carpentier P.H.
        • Maricq H.R.
        • Biro C.
        • Jiguet M.
        • Seinturier C.
        Paroxysmal finger haematoma–a benign acrosyndrome occurring in middle-aged women.
        VASA. 2016; 45: 47-62https://doi.org/10.1024/0301-1526/a000496