The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Achenbach’s Syndrome

Yu Yamamoto, M.D.
Sayaka Yamamoto, M.D.
Jichi Medical University School of Medicine
Shimotsuke, Japan
u-bou@​­jichi​.­ac​.­jp

A
previously healthy 66-year-old woman presented with sudden-onset pain and bruising in
her right middle finger. She had had a similar episode 3 weeks earlier, which had resolved spontaneously
within a few days. She did not take any regular medication and reported that she had not had any recent
trauma. A physical examination revealed subcutaneous hematoma and swelling with normal capillary refill and
sensation. The skin color of the fingers did not change in response to exposure to cold. Laboratory tests revealed a
normal platelet count and no coagulopathy. A clinical diagnosis of Achenbach’s syndrome was made. Achenbach’s
syndrome is characterized by paroxysmal spontaneous subcutaneous bleeding in the fingers and hands. Although
the cause is unknown, it is a self-limiting condition. Patients may seek medical care out of fear because of the sudden
pain and bleeding; therefore, diagnosing this condition may relieve anxiety. The patient’s signs and symptoms resolved
spontaneously within 1 week without treatment.
DOI: 10.1056/NEJMicm1610146
Copyright © 2017 Massachusetts Medical Society.

n engl j med 376;26 nejm.org June 29, 2017 e53

The New England Journal of Medicine
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