Achenbach Syndrome: Clinical Management
Diagnosis and Reassurance
Achenbach syndrome is a benign, self-limiting condition requiring no specific treatment beyond patient reassurance and observation. 1, 2
The diagnosis is entirely clinical and should be made based on the characteristic presentation of sudden bruising, pain, and swelling affecting the volar aspect of one or more fingers, typically the proximal and middle phalanges 1, 3. The condition resolves spontaneously within 2-3 days, though discoloration may persist longer 1.
Clinical Presentation to Recognize
- Sudden onset of intense burning pain in one or more fingers, sometimes preceded by tingling, itching, or numbness 1, 3
- Dramatic bruising appearing on the volar (palm-side) surface of the proximal and middle phalanges 1, 4
- Spontaneous occurrence or development after minimal trauma 3, 4
- Middle-aged to older women are most commonly affected 4
Diagnostic Workup
All laboratory and imaging investigations will be normal in Achenbach syndrome. 1, 2
- Routine blood tests, coagulation studies, and thrombophilia screens are uniformly negative 1
- Vascular imaging and echocardiography show no abnormalities 1
- Avoid extensive diagnostic workups once the clinical diagnosis is established, as they are costly and unnecessary 4, 2
Management Approach
The primary management is patient education and reassurance about the benign nature of the condition. 3, 4, 2
- Do not initiate anticoagulation despite the alarming appearance, as the condition resolves spontaneously and anticoagulation provides no benefit 1
- Observe for spontaneous resolution over 2-3 days 1, 3
- Counsel patients that recurrences may occur years later but remain benign 1, 4
Special Consideration: Post-COVID-19 Cases
- In patients with recent COVID-19 infection recovery presenting with Achenbach syndrome, synthetic prostacyclin receptor agonist (Iloprost) may be considered as first-line conservative treatment 5
- This recommendation is based on the hypothesis that SARS-CoV-2-induced endothelial damage and microthrombosis may trigger the condition 5
Key Clinical Pitfall
The dramatic presentation often leads clinicians to unnecessarily start anticoagulation or pursue extensive vascular workups. 1, 2 Recognize that despite the alarming appearance, this condition requires only observation and reassurance. The greatest clinical value lies in correctly identifying the syndrome to avoid subjecting patients to unwarranted interventions and to provide appropriate reassurance about its benign, self-resolving nature 4, 2.