Hematohidrosis: A Rare Case of Blood Sweating.

Abstract

Background: Hematohidrosis is an extremely rare condition characterized by the spontaneous exudation of blood through intact skin, often linked to emotional stress and sympathetic nervous system activation. Due to its rarity, many aspects of its pathophysiology remain poorly understood. This case highlights the importance of considering hematohidrosis in the differential diagnosis of unexplained bleeding and emphasizes the role of psychological assessment in its management.

Case presentation: A 7-year-old girl from a low-income background presented with a two-month history of recurrent blood oozing from the sweat glands at her elbows, knee joints, and forehead. The episodes, lasting 5-10 minutes, were more frequent during periods of emotional distress. Physical examination revealed no signs of trauma, purpura, or underlying skin lesions. Routine laboratory investigations, including hemogram, platelet count, clotting time, prothrombin time, and activated partial thromboplastin time, were within normal limits. Microscopic analysis of the secreted fluid confirmed the presence of erythrocytes, supporting the diagnosis of hematohidrosis. Given the suspected psychogenic trigger, the patient was referred for psychiatric evaluation and stress management therapy, leading to a gradual reduction in symptom frequency over a four-month follow- up period.

Conclusion: This case reinforces the multidisciplinary approach required for diagnosing and managing hematohidrosis, which lacks definitive diagnostic markers. Early psychological intervention is crucial in mitigating symptom severity, as evidenced by this patient's clinical improvement. Increased awareness of hematohidrosis among clinicians can prevent unnecessary invasive testing, facilitate timely recognition, and optimize patient outcomes.