Scary secretions.
In what sounds like a horror movie, an 11-year-old Indian boy began inexplicably bleeding out of his eyes, nose and ears.
According to the case, documented in Sage Journals, the boy’s bloody episodes began for no obvious reason, caused the child no pain, and typically stopped within minutes.
His parents took him to an emergency room after the disturbing episodes persisted for more than a month. Upon examination, doctors could find no clear source or cause for the bleeding.
While test results confirmed the presence of blood in the secretions, they showed that the boy had normal blood counts and von Willebrand factor levels.
He was ultimately diagnosed with hematohidrosis, also known as “bloody sweat,” a rare disorder where a patient will spontaneously secrete blood or a blood-tinged fluid through sweat glands, the mouth, nose, ears, tear ducts or nipples.
Hematohidrosis is notoriously difficult to diagnose and can be mistaken for self-harm, Munchausen syndrome or other bleeding disorders like von Willebrand disease, which compromises the body’s ability to form blood clots.
Incredibly rare, fewer than 50 cases of hematohidrosis have been documented, though study authors note that symptoms are more likely to occur in adolescents, particularly in Asian populations in India and Pakistan.
Approximately 84% of patients who present with hematohidrosis are female.
Hematohidrosis episodes are commonly associated with extreme emotional or psychological stress.
In this case, the boy’s parents noted that the bleeding often coincided with the trifecta of “academic stress, peer pressure, or parental expectations regarding academic performance.”
Owing to this, the boy and his parents were given a psychological assessment outside of active bleeding episodes.
The psychiatrist assigned to the case focused on identifying the emotional triggers, behavioral responses, and psychosocial stressors that accompanied each episode.
The boy reported that he experienced serious anxiety related to school performance and what he perceived as parental pressure to achieve.
Impressions were drawn from behavioral observations during the session, the child’s self-reports, and interviews with his caregivers.
The boy was subsequently treated with propranolol, a beta blocker that can reduce the body’s fight-or-flight response and lessen anxiety.
He also began cognitive behavioral therapy to help build coping skills for emotional regulation, integrate relaxation techniques, and implement adaptive strategies to help him better manage academic pressure.
The child’s parents also underwent counseling sessions to lessen the pressure to perform and create a more supportive, less triggering home environment.
Within two weeks of medical intervention, the bleeding episodes declined dramatically.
Within four weeks, the boy reported only a few mild episodes, and within three months, he was free of frequent bleeding.
Study authors note that early diagnostic recognition of hematohidrosis is critical to avoid unnecessary tests and ineffective treatment.
They are hopeful this case will shed light on the rare condition and spare future patients and caregivers from unnecessary investigation, intervention, and anxiety.
“This case highlights the importance of recognizing haematohidrosis as a rare clinical condition in which psychosocial factors may play a contributory role, and emphasizes the role of multidisciplinary management to achieve favorable outcomes,” the study authors said.
