Recurrent Hematoma in the Finger and Leg: Achenbach Syndrome

      A 35-year-old woman presented with sudden pain, edema, and bruising in her right second finger. There was no history of trauma or other causative triggers, such as cold exposure, stress, or medication. The patient was a nonsmoker with no significant medical history. On physical examination, her second finger showed a subcutaneous hematoma distal to the metacarpophalangeal joint on the palmar and dorsal sides, and the range of motion of the affected finger was slightly restricted because of swelling (Figure A). The finger was warm, capillary refilling was normal, and there was no sensory disturbance. Blood test results showed a normal platelet count and no coagulopathy. When she returned for a follow-up visit 1 week later, her symptoms had already resolved spontaneously without treatment. A detailed medical history revealed that the patient had experienced the same symptoms several times per year for a couple of years. The symptoms were usually located in the second or third fingers and less frequently in the lower legs (Figure B). In all cases, the pain was accompanied by edema, and coloration change occurred within minutes to hours of onset and resolved spontaneously within 1 week. A clinical diagnosis of Achenbach syndrome was thus established.
      Figure(A) Subcutaneous hematoma and swelling in the right second finger. (B) Subcutaneous hematoma in the right lower leg.
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