hematohidrosis is known to be precipitated by stress , strain , or any sort of exertion , and it may occur in individuals with underlying bleeding disorders .
it may occur in individuals suffering from extreme levels of stress . around the sweat glands , there are multiple blood vessels in a net - like form , which constrict under the pressure of great stress .
then , as the anxiety passes , the blood vessels dilate to the point of rupture and goes into the sweat glands . as the sweat glands produce a lot of sweat , they push the blood to the surface , which comes out as droplets of blood mixed with sweat .
we hereby report a case where bloody sweat discharged from the forehead , face , and body episodically in a healthy young girl who did not have any underlying disorders .
a 12-year - old girl visited us with a history of bleeding from the intact skin over the forehead , scalp , cheek , nose , and trunk [ figures 1 and 2 ] for the last 2 years .
the bleeding occurred in episodes , once or twice a day , sometimes more frequently , especially on waking up in the morning .
no preceding history of stress or anxiety and no preceding episode of tingling sensation were found .
each episode started with mild watery secretion over the forehead or other body parts , followed immediately with bright - red colored secretion .
each episode lasted for about 10 - 15 min , and the patient remained perfectly alright during the post - episode period until the next episode .
no history of ingestion of any anticoagulants , dyes , or other drugs was obtained from her .
she did not have any history of major medical or surgical illness in the past .
sweat admixed with blood from the right side of the face sweat admixed with blood from nose her general physical examination and systemic examinations did not reveal any abnormality . the skin over the forehead was normal .
on gross examination , the secretion was bright - red in color , less viscous than blood , and it was not frank blood . on collection of the secretion and examination of its smeared preparation under a microscope , plenty of erythrocytes were observed ; the sample was benzidine test positive [ figure 3 ] and alkaptonuria negative .
her routine hemogram , blood counts , platelet count , bleeding time ( 2 min ) , clotting time ( 3 min 30 sec ) , active partial thrombin time ( 25 sec ; normal range 24 - 32 sec ) , prothrombin time , liver function tests , and renal function tests were within normal limits .
peripheral smear of the secretion showed multiple red blood cells ( rbcs ) along with numerous gram - positive cocci and bacilli [ figure 4 ] .
benzidine test of the secretion , confirming presence of blood peripheral smear of the secretion showing rbcs and numerous cocci and bacilli psychiatric analysis revealed intelligent quotient ( i.q . ) between 60 and 70 and a loss of insight .
the patient was given atropine transdermal patch over the involved sites and she noticed gradual improvement in both the severity and frequency of the episodes .
we followed the patient for 2 months after stopping the atropine treatment . during this period
hematohidrosis also known as hematidrosis , hemidrosis , and hematidrosis is a condition in which capillary blood vessels that feed the sweat glands rupture , causing them to exude blood ; it occurs under conditions of extreme physical or emotional stress .
various causative factors have been suggested by holoubek , like component of systemic disease , vicarious menstruation , excessive exertion , psychogenic , psychogenic purpura , and unknown causes . acute fear and intense mental contemplation are the most frequent causes , as reported in six cases in a study . in our case ,
one hypothesis proposed for etiopathogenesis of hematohidrosis , as suggested by some authors , is that multiple blood vessels present in a net - like form around the sweat gland constrict under pressure of stress .
as the anxiety passes out , the blood vessels dilate to the point of rupture .
the blood goes into the sweat glands , which push it along with sweat to the surface , presenting as droplets of blood mixed with sweat .
severe mental anxiety activates the sympathetic nervous system to invoke stress - fight reaction to such a degree as to cause hemorrhage of the vessels supplying the sweat glands into the ducts of the sweat glands .
they concluded that pathological basis for hematohidrosis might be distinctive vasculitis , but direct immunofluorescence study did not reveal any abnormality in our case .
biopsy during symptom free period did not reveal any blood - filled vascular spaces , intradermal bleeding or abnormality in hair follicle , sebaceous , or sweat glands .
benzidine test is an important tool in diagnosis , where hemoglobin in blood reacts with hydrogen peroxide - liberating oxygen , which then reacts with organic reagent producing a green to blue colored compound .
we believe that a further insight in the etiopathogenesis may help develop more comprehensive management protocol of this rare and unusual condition .
1 . in our case , no underlying precipitating factors such as stress , strain , or any bleeding disorder was identified .
 hematohidrosis is a very rare condition in which an individual sweats blood . 
 it may occur in an individual who is suffering from extreme levels of stress . 
 various causative factors have been suggested like component of systemic disease , vicarious menstruation , excessive exertion , psychogenic , and unknown causes . 
 fear and intense mental contemplation are the most frequent causes 
 . it may also occur in bleeding disorders . 
 we here report a case where bloody sweat was discharged from the forehead , face , and body episodically in a 12-year - old healthy girl with no bleeding disorder or any other underlying cause . 
 all investigations done were within normal limits , except low intelligent quotient and loss of insight . 
 the patient was given atropine sulphate transdermal patch with marked improvement in severity . 
Introduction
Case Report
Discussion