THE VANISHING GHASTLY BLEEDS - HEMATOHIDROSIS

Hematohidrosis is a very rare clinical phenomenon of sweating blood. A 10 year old female child presented to us in march 2012, with a history for bleeding from the scalp on and off for the past 3 days. There was a history of head tonsure 2 weeks back and a trivial head injury 5 days back. With this history the child was worked up for a bleeding disorder. But the entire coagulation work up was normal including the factor XIII assay. The site of bleed was also not specific, it varied and lasted for 5 to 10 mins only. The child reported a sort of tingling sensation before the bleed started at that particular site. Once the blood was wiped off, there was neither a sign of injury nor any bleed site identifiable on the scalp which made us suspect that it was a sweat and not blood alone. The bleeding was also painless. We then suspected hematohidrosis based on a few case reports in literature. The sweat was sent for a microscopic analysis, which proved the presence of RBCs and the benzidine test confirmed the same. Since a strong association between psychological stress and this condition has been postulated, we sent the child for a psychiatric opinion. A skin biopsy was also performed which was normal. The child improved subsequently with no specific medications. The child who is on regular follow up now is doing well with no subsequent episodes. We report this case for its rarity. And as of now no specific treatment has been devised for this extremely rare phenomenon.