Diagnosis of autoerythrocyte sensitization syndrome in the emergency department.

Autoerythrocyte sensitization syndrome is characterized by sudden and spontaneous painful bruising and swelling occurring in young female patients with psychiatric disorders. This syndrome may present with such severe swelling of involved areas that aspiration or excision may be needed to relieve pressure. The presentation of this condition in the emergency department must be differentiated from more common coagulopathies. Differentiation from the self-mutilation disorder, which often presents to the ED, can be difficult. Although the pathogenesis is uncertain, purpuric lesions are reproduced by injections of washed red cell erythrocyte stroma, suggesting an autoimmune etiology. We describe a patient with recurrent bruising diagnosed in the ED who responded with classic inflammation to autologous injection of red blood cells.