Recurrent spontaneous petechiae and ecchymoses in a 14‐year‐old girl

A 14-year-old Caucasian girl was admitted to our department due to recurrent skin lesions appearing without any inducing factor. First lesions emerged about a year before admission and were preceded by severe headache and eye pain. The girl reported having had problems in school for two years and having been bullied due to her nervous breakdown about a year earlier. Since then, she has limited her contacts with school peers and experienced loss of appetite and sleeping problems. On admission, physical examination revealed multiple, disseminated petechiae and ecchymoses of various size. The lesions were located mostly on her chest, neck and face (Figure 1a–d), however the patient provided photos of previous lesions in other localizations. According to the anamnesis, similar skin lesions tended to appear spontaneously, though the occurrence was preceded by a burning sensation and a feeling of discomfort at the site of future lesions, as well as severe headaches. The patient denied self-harm and any possible trauma. A few days later the lesions would disappear without leaving permanent skin damage and relapse at 2–3 weeks intervals. Due to the lack of abnormalities in laboratory tests and clinical picture, the girl was diagnosed with self-inflicted skin lesions or physical abuse. The prescribed treatment with etamsylate neither improved the clinical picture, nor prevented relapses. During the last hospitalization in our department, the patient was consulted by psychiatrist and psychologist who observed traits of personality disorder and mild depression. Recurrent spontaneous petechiae and ecchymoses in a 14-year-old girl Case for Diagnosis