title: 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.affiliation: Department of Haematology, Children's Hospital and Institute of Child's Health, Lahore.
authors.forename: Unaiza
authors.initials: U
authors.lastname: Qamar
authors.affiliation: Department of Haematology, Children's Hospital and Institute of Child's Health, Lahore.
authors.forename: Nisar
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Department of Haematology, Children's Hospital and Institute of Child's Health, Lahore.
authors.forename: Saima
authors.initials: S
authors.lastname: Farhan
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D005162:Factitious Disorders / Q000175:diagnosis* / Q000188:drug therapy; D006470:Hemorrhage / Q000209:etiology / Q000523:psychology*; D006801:Humans; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use; D011602:Psychophysiologic Disorders / Q000188:drug therapy / Q000209:etiology*; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy; D017445:Skin Diseases, Vascular / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline