Sir, the recent letter by Y. A. Picón-Jaimes et al.1 has complemented our earlier case report on Achenbach's syndrome,2 by drawing attention to a publication that we had missed and which illustrated a single case of Achenbach's syndrome that had an association with recurrent subconjunctival haemorrhages.3

The authors had also previously written to the Journal of the Royal Society of Medicine Open (JRSM Open) with the same notification,4 in response to our original, more detailed publication on the possible association between Achenbach's syndrome and joint hypermobility.5

In that JRSM Open letter,4 Higuera-Cetina et al. had also cited a report that illustrated a familial association between three related women, which had suggested a possible genetic cause for their finger bleeds.6 As such, they then felt this hypothesis had been reinforced by our report of the two female sibling Achenbach cases who had also co-presented with joint hypermobility.5 However, this is not surprising bearing in mind that many regard joint hypermobility syndrome as being synonymous with Ehlers-Danlos Type III syndrome, which is inherited through an autosomal dominant pathway, even if the genes responsible have yet to be identified.7

As such, in light of the above two additional associations of subconjunctival haemorrhages and a familial trait to screen for in patients who report with paroxysmal, subcutaneous finger bleeds, we still believe the main focus of attention should be on searching for more cases that may also present with joint hypermobility, in order to further substantiate the existence of an association with Achenbach's syndrome, as a means thereafter if found, of encouraging the initiation of subsequent research into the possible pathophysiological mechanisms of its causation.