Is Achenbach's syndrome a surgical emergency? A systematic review

A curious case of a blue finger

ABSTRACT

This article describes an unusual presentation of a blue finger in a middle-aged woman with no significant past medical history. The patient was diagnosed with Achenbach syndrome, a rare condition that is generally considered transient and benign. The underlying pathophysiology of this condition is unclear, but may be related to transient subcutaneous ecchymosis, possibly from microtrauma. If the condition recurs, a workup can include laboratory tests for autoimmune diseases such as rheumatoid arthritis. Clinician awareness of this presentation may reduce patient anxiety and unnecessary testing.

Achenbach Syndrome: Case Report and Discussion

Achenbach syndrome is a rare, benign, self-limiting condition characterized by spontaneous, recurrent bruising of the digits without evidence of systemic disease or predisposing factors. We report a middle-aged Caucasian female that presented to the outpatient clinic with spontaneous bruising on the dorsal aspect of her left first metacarpal. Diagnosis of Achenbach syndrome was made through history and physical examination findings, and the patient was discharged with instructions to follow up as needed. It is important for providers to consider Achenbach syndrome to reassure patients and prevent an expensive or invasive workup.

Achenbach Syndrome: A Case Series

Achenbach syndrome, also known as "paroxysmal finger haematoma", is a rare, benign, self-limiting condition with unknown etiology that results in an acute onset swelling and pain, and subsequently blue discoloration of the fingers and sometimes the feet. The pathophysiology of this syndrome is not entirely clear, but intermittent spontaneous hematoma formation is reported as its characteristic symptom. Achenbach syndrome is more predominant in the female population. There are no known risk factors such as trauma, drug use, bleeding disorders, or rheumatologic diseases associated with the etiology of this syndrome. Although the symptoms are alarming to patients, the condition itself is not accompanied by any significant complications.

Herein we present our case series of four patients experiencing symptoms compatible with the diagnosis of Achenbach syndrome. The aim of this study is to increase awareness of this condition and its benign nature to avoid unnecessary referrals or invasive procedures and investigations as well as alleviate the anxiety of patients.

Achenbach syndrome in an older man

Dermatologists should consider Achenbach syndrome in the differential diagnosis for patients with purpura on the fingers. The patient should be monitored following appropriate examination and invasive tests, such as skin biopsy or angiography, should be avoided unless necessary.

Achenbach’s Syndrome Revisited: The Paroxysmal Finger Hematoma May Have a Genetic Link

Achenbach’s syndrome describes the sudden occurrence of bruising, pain and swelling of one or more digits of the hand involving the volar aspect of the proximal and middle phalanges. Also known as the paroxysmal finger hematoma, it presents in dramatic fashion, sometimes with a prodrome of tingling, itching or numbness but despite its dramatic presentation, all investigations are normal. Routine blood investigations, as well as coagulation and thrombophilia screens are all negative as are vascular imaging and echocardiography. The diagnosis is solely clinical. Due to the nature of its presentation, almost all patients are referred for an urgent vascular consultation but the condition resolves spontaneously usually within 2–3 days, although the discoloration may persist for longer. Its appearance usually leads clinicians to start anticoagulation in the belief that it may progress but, in fact, it settles as quickly as it appears. Though there are episodic cases which recur years later, it is generally self-resolving with no complications nor residual morbidity. Although the etiology was previously unknown, there is now a recognized genetic link. Genes related to the acute phase reactive proteins and the coagulation and complement cascades appear to be linked to Achenbach’s syndrome. This evidence may explain why only certain individuals seem prone to this acutely painful, bruising disorder. We review this interesting disorder and compare patients from the tropical Caribbean region with similar cases from the temperate United Kingdom and discuss whether there are climatic variations in presentations.

Achenbach syndrome as a rare cause of painful, blue finger

Paroxysmal finger hematoma, also known as Achenbach syndrome, is an underdiagnosed condition that causes apprehension in patients owing to the alarming appearance. It usually presents as a blue-purple discoloration of the volar aspect of one or more digits and can be associated with pain and paresthesia. This condition is benign and is usually self-limiting.

Achenbach's hand and digital paroxysmal haematomas: a possible association with joint hypermobility syndrome in two sibling cases

A pair of middle-aged sisters is presented who experienced episodes of spontaneous, relatively atraumatic, acute onset, painful sub-cutaneous bleeding into the digits of their hands over a number of preceding years. A literature search revealed they had Achenbach’s syndrome, which is a benign and self-limiting condition that resolves completely within 2–4 days. However, a hitherto unreported association between Achenbach’s syndrome and joint hypermobility with its abnormal collagen is made, along with a tentative causality hypothesis that perhaps in the presence of atypical connective tissue, the architecture and integrity of the peripheral capillary bed of the hand could be adversely affected and therefore predispose towards paroxysmal palm and/or finger bleeds.

An Acute Blue Finger: A Case of Achenbach's Syndrome

Achenbach’s syndrome, also known as paroxysmal finger haematoma, is a rare condition that results in spontaneous bruising and pain in one or more fingers. Despite its benign and self-limiting course, the remarkable clinical presentation can suggest serious vascular and haematological disease leading to unnecessary referrals and invasive investigations. The authors present the case of a 60-year-old woman with an acute painful and bruised finger. All other physical findings and investigations were normal, except for autoimmune thyroiditis. Based on the clinical presentation and course, the diagnosis of Achenbach’s syndrome was made and the symptoms resolved without treatment.

Achenbach syndrome (paroxysmal finger hematoma)

Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the subsequent appearance of a hematoma on the palmar side of the proximal phalanges. Achenbach syndrome is a benign condition of unknown etiology in which prodromal symptoms, such as pain, tingling, and itching, may occur from minutes to hours before the color change appears. The subdermal bleeding usually stops spontaneously or after local pressure is applied. The color changes usually disappear within a few days, without permanent sequelae. The diagnosis of Achenbach syndrome is based strictly on its clinical features because the results of all routine investigations are usually normal. Physicians should become aware of this condition in order to advise their patients about its benign prognosis and to avoid unnecessary testing.

Analysis of 24 patients with Achenbach's syndrome

BACKGROUND

Achenbach’s syndrome is a rare condition, and the etiology is unknown. It is most commonly seen in the volar plate of the hand distal interphalangeal joint. Patients diagnosed with Achenbach’s syndrome in cardiovascular surgery clinic were retrospectively compared with the literature.

AIM

To investigate the symptoms, findings, sociodemographic conditions, and laboratory data of patients diagnosed with Achenbach’s syndrome.

METHODS

The study is a retrospective review of 24 patients diagnosed with Achenbach’s syndrome at Afyonkarahisar State Hospital between March 2015 and November 2016, at Sivas Numune Hospital between November 2016 and November 2017, and at Cumhuriyet University Cardiovascular Surgery Department between November 2017 and November 2018. In the study, demographic characteristics of the patients, signs and symptoms of the disease, and laboratory data were analyzed retrospectively.

RESULTS

The cohort consisted of 83.33% female patients and 16.67% male patients. The disease was most commonly located in the index finger of the right hand. All of the patients complained of bruising and pain. No pathologic findings were present in the laboratory results. According to these results, it can be concluded that Achenbach syndrome is most commonly seen in the right index finger of middle-aged female patients.

CONCLUSION

Further research is needed to clarify Achenbach’s syndrome and to develop a diagnosis and treatment algorithm. As the awareness of this syndrome increases, large amounts of data will be obtained. According to current knowledge, Achenbach’s syndrome is not among the known causes of mortality or morbidity. However, it is unknown whether it is seen in brain or other vital organs.

Achenbach's syndrome in an elderly woman

Achenbach's syndrome is a rare condition, but may be encountered in the primary care setting. The symptoms may be surprising to the patient and cause anxiety.