(BMJ)—A woman in her 50s presented with sudden stinging at the base of her L palm, followed by the development of purple discoloration ~30 min later. Exam: no evident trauma, no pallor, normal temp of fingers, capillary refill <2 sec. Duplex U/S of radial and ulnar artery WNL. What’s the dx?
Immune thrombocytopenia
Raynaud syndrome
Vitamin C deficiency
Achenbach syndrome
Buerger disease
You are correct. Achenbach syndrome most commonly occurs in postmenopausal women and is due to thinning of veins in the fingers and palms, with subsequent leakage of blood into the surrounding dermis. Leakage is typically triggered by increased pressure to the area (e.g., when carrying plastic bags). Bruising usually disappears within a few days.

Achenbach syndrome is a dx of exclusion. DDx includes bruising caused by clotting disorders or low platelet count, capillary fragility from vitamin C deficiency or amyloidosis, and vascular ischemic events (embolism or vascular spasm). Although the exact cause of Achenbach syndrome is unknown, sx might recur, as in this patient; thus, explanation and reassurance are important.

BMJ 2022;377:e070769