Hematohidrosis syndrome, a rare condition characterized by spontaneous discharge of blood from intact skin and mucosa, is described in a new case published in the Canadian Medical Association Journal.

The patient, a 21-year-old female, reported a 3-year history of bleeding episodes on her palms and face which were self-limiting and were not associated with skin lesions. The bleeding episodes, which could last anywhere from 1 to 5 minutes, occurred both during the day and at night and were intensified by emotional stress. 

Laboratory tests (CBC, coagulation studies) were conducted but the findings were all within normal range. Initially, the authors included both factitious disorder and hematohidrosis in their differential diagnosis, however, upon further examination, they concluded that there was no evidence to suggest factitious disorder. The patient also reported symptoms of depression and anxiety for which she was treated with paroxetine and clonazepam.

Reprinted with permission from CMAJ.

During the patient’s admission, a bleeding episode occurred which resulted in blood-stained fluid on her face. Microscopic examination showed the presence of erythrocytes which led to a diagnosis of hematohidrosis. “Histologic analysis of the skin in an area of bleeding was normal,” the authors noted.

The cause of hematohidrosis remains unknown as does the source of bleeding. “Despite the fluid’s sweat-like appearance, the hypothesis that blood passes through eccrine ducts, induced by abnormal constrictions and expansions of periglandular vessels, has not yet been proven,” the authors write.  Excessive exertion, psychogenic disorders, menstruation, and bleeding disorders have all been described as possible causes of hematohidrosis. 

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Based on previous literature, the patient was treated with propranolol 20mg daily. While treatment reduced her bleeding episodes, it did not lead to complete remission.

For more information visit CMAJ.ca.