Case report of a 21 year old woman sweating blood

By Dr. Ananya Mandal, MDOct 24 2017

A 21 year old woman was admitted to an Italian hospital under care of Drs. Roberto Maglie and Marzia Caproni from Department of Medical and Surgical Critical Care, Section of Dermatology, at the University of Florence. She had a rare condition called hematohidrosis where she was sweating blood and her tears too contained blood. The dermatologists published the report of her rare case while protecting her identity, this week in the Canadian Medical Association Journal.

The doctors report that the woman present with no visible injuries to her skin that could explain the bleeding. She reported that each time she started bleeding through her sweat pores in her skin, she had no trigger of any sort. The bleeding continued for one to five minutes before stopping on its own. It could occur while the lady was sleeping or when she was active and exercising – i.e. her activity at the time of the episodes was not determining the bleeding episodes. This condition had been troubling her for the past three years, write the authors of the report. The problem led to her social isolation leading to mental health problems such as major depression and even panic disorder, they explain.

The doctors tested her skin to look for any abnormality that could be causing this problem. They found that her blood clotting system (prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) was normal and her blood was normal on all other tests. A bit of her skin was tested as a biopsy specimen to check for any skin disorder. No abnormality was noted in her skin structure as well.

As a treatment, the first approach was to treat her mental health problems – panic attacks and major depression. They used common antidepressant Paroxetine and anxiety relieving drug clonazepam to stop the panic attacks. A beta blocker Propranolol, that is used for several heart conditions as well as other disorders was used to control the bleeding. The authors write that her bleeding was reduced with propranolol but was not completely eliminated.

Hematohidrosis or Sweating Blood

One of the earliest mentions of this “blood sweat” disease or hematohidrosis dates back to third century B.C. in the writings of Aristotle. Not much is known about the exact cause ort pathology behind this rare and bizarre condition even today. In some literature this bleeding has been associated with abnormal menstruation called “vicarious menstruation” or with other diseases such as epilepsy, scurvy (deficiency of vitamin C) or malaria. None of the associations have been proven though. Excitement or physical activity that leads to sympathetic outflow has been associated in some studies and reports.

There may be pain or a tingling sensation when the bleeding occurs but this may be absent in many patients. There are accompanying headaches and many of these patients suffer from high blood pressure too. Although a majority of the sufferers are women, men can also get this condition. The most common sites of bleeding include scalp, forehead, eyes and ears.

There is no specific treatment for this rare condition. Other medications such as Atropine used as a skin wipe has been tried and proven to be of moderate use. Many case reports show that the condition may resolve on its own without treatment as well.

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