Rare case of sweating of blood reported in JAPI

Hematohidrosis is an extremely uncommon phenomenon of blood sweating. There are only a few reports in the literature. Leonardo Da Vinci to Physician Luke described that a common soldier to even Jesus Christ had also experienced a such event during critical moments. Hematohidrosis is a state where the capillary blood vessels that supply sweat glands explode, resulting in the perspiration of blood, occurring under excessive physical or emotional stress.

Hematohidrosis is an uncommon pathophysiological condition of sweating blood. A young lady with abrupt bleeding from the skin (since January 2017) was brought to the emergency. The bleeding was vanished after mopping with no site of injury, but it reappeared soon enough confirming its nature. Bleeding time (BT), clotting time (CT), and the prothrombin time (PT) was within normal limit. This patient is confirmed as a case of hematohidrosis by the method of exclusion and the presence of blood was finalized by benzidine test as well as biochemical and microscopic examination of it. Now, no treatment is available as per the latest pieces of evidence. Also, the cause of it is not known till date. Psychological anxiety is a predisposing cause for hematohidrosis.

Manonukul et al. suggested the word "hematofolliculohidrosis" as it is visible with liquid like sweat and the blood is going out through follicular channels. Many reasons have been mentioned by Holoubek, such as a part of systemic disease, vicarious menstruation, immense exhaustion, psychogenic purpura, etc. Sudden anxiety and psychogenic strain are the most common causative agents, as evidenced before. Here, the most possible cause of it was acute on chronic mental strain, as the other etiologies were nullified by comprehensive history taking and laboratory testing. Psychogenic purpura is caused by hypersensitivity to the patient's blood or autoerythrocyte sensitization and is specified by recurring episodes of ecchymoses, gastrointestinal (GI) bleeding, and hematuria.

To conclude, though it is a very rarely reported case in medical literature, it is essential to keep a close watch on our daily patient interactions to register more cases of hematohidrosis to know further about it. It should also be encouraged to do skin biopsy to be done during acute episodes not later on.

Reference:

Chatterjee A, Chowdhury DK, Kundu A, et al. A Rare Case of Blood & Sweat: Hematohidrosis. J Assoc Physicians India 2022;70(10):81–82.

Keywords:

Rare, Case, Blood, Sweat, Hematohidrosis, Abhijit Chatterjee, Dip K Chowdhury, Arnab Kundu, Jayanta Datta, J Assoc Physicians India