A curious case of sweating blood

Biswas, Samar; Surana, Trupti V; De, Abhishek; Nag, Falguni

doi:10.4103/0019-5154.119964

Cited by 27 publications

(21 citation statements)

References 5 publications

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“…were able to identify multiple distinct blood‐filled dermal spaces opening directly onto the skin surface or into follicular canals in their patient. Support has been found in the efficacy of propranolol and atropine in a few case studies in the literature, but our patient did not respond to these therapies. Other case studies report success with anxiolytics such as lorazepam, presumably associated with a reduction in anxiety producing a reduction in diaphoresis rather than modifying the underlying pathology.…”

Section: Discussionsupporting

confidence: 80%

“…Following success in case reports by Wang et al ., we trialled her on propranolol; however, this was ineffective for our patient at a maximally tolerated dose. A recent report by Biswas et al . found atropine transdermal patches to be effective, but patch application is not practical given the location of our patient's bleeds.…”

Section: Investigation Findingsmentioning

confidence: 75%

“…The pathophysiology underlying this condition is unclear; however, previous published case studies suggest a strong temporal association between stress and the occurrence of the bleeding episodes. Biswas et al . suggest that the bleeds may be secondary to blood vessels dilating and rupturing into the sweat glands following a sympathetic vasoconstriction in response to a stressful trigger.…”

Section: Discussionmentioning

confidence: 99%

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Blood sweat and tears ‐ tackling the stigma of stigmata

Tin

Cohn

2015

J Paediatrics Child Health

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Our patient was a 14-year-old girl who presented with a 3-week history of intermittent fresh bleeding from her conjunctiva, nose, ears and nail beds. The bleeds would occur spontaneously with no obvious triggers, and would last for several minutes. She sought further medical attention because of the increasing frequency and duration of the bleeds, which were consistently worse during the warmer months.With respect to the haemolacria (Fig. 1), she gave no history of conjunctival trauma, and complained of no associated ocular pain or irritation. The bleeds would initially begin as a trickle of blood along the conjunctiva lining her lower eyelid, but could become profuse with clots and spill over her cheeks. It was noted that when she cried physiological tears they appeared normal.She next presented with spontaneous bleeds from the hair follicles in her scalp (Fig. 2). This could occur several times in a day, and was associated with a bilateral temporal pulsating headache. We were able to witness and record multiple spontaneous bleeding episodes during her hospital admissions.She had begun regularly menstruating a year before these episodes began, and other than menorrhagia, her cycles were normal and had no temporal association with her bleeding episodes and her menstrual cycles. We trialled her on the oral contraceptive pill, which did not change either the frequency or intensity of her spontaneous cutaneous bleeds, of which she continued to have up to 20 episodes per day. Similarly she had no symptomatic improvement with either the subdermal progesterone implant or transexamic acid.Opinion was sought from multiple Specialty teams, including haematology, opthalmology, dermatology, gynaecology, ENT and rheumatology, but they were not able to offer an explanation for her bleeding tendency despite multiple investigations (Table 1).We have done multiple literature searches in an attempt to identify other potential interventions to help our patient. Following success in case reports by Wang et al., 1 we trialled her on propranolol; however, this was ineffective for our patient at a maximally tolerated dose. A recent report by Biswas et al.2 found atropine transdermal patches to be effective, but patch application is not practical given the location of our patient's bleeds. Systemic atropine seems inappropriate with respect to the potential side effects.We have continued to monitor her clinical course in the General Paediatric clinic. At the peak of her bleeding episodes, she progressed to have bleeds from her palms, feet and ears, in Key Points1 Unexplained intermittent bleeding in the paediatric setting poses a diagnostic dilemma for clinicians. 2 Haematohidrosis is an unusual presentation without a defined pathogenesis. It is important to consider a range of haematological and other organic diagnoses, in addition to the potential psychological causes and effects of the symptoms. 3 In the face of medically unexplained symptoms, it is important for clinicians to maintain an open mind in working through differential dia...

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Section: Discussionsupporting

confidence: 80%

Section: Investigation Findingsmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Blood sweat and tears ‐ tackling the stigma of stigmata

Tin

Cohn

2015

J Paediatrics Child Health

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“…There is no specific treatment for this condition. Although some reports indicate no response to vitamin C or hemostatic medications, some patients have responded to lorazepam, atropine, and propanol . To the best of our knowledge, the response shown by the present patient to the local application of adrenaline has not been previously reported in the literature.…”

Section: Discussioncontrasting

confidence: 41%

Hematidrosis on the forehead following trauma: a case report

2016

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“…Fortified MBEH therapy may inadvertently affect melanocyte viability in extracutaneous sites, which could affect hearing or visual acuity; however, melanocytes in immune-privileged sites are relatively protected from such responses. Indeed, there is minimal evidence for hearing or visual impairment in vitiligo (98)(99)(100). By contrast, a significantly advantageous effect of this therapy could include targeting of occult melanomas, as supported by previous studies (15,19).…”

Section: Enhanced Bleaching Treatment For Vitiligomentioning

confidence: 99%

Enhanced bleaching treatment: opportunities for immune‐assisted melanocyte suicide in vitiligo

Webb

Eby

Hariharan

et al. 2014

Experimental Dermatology

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Depigmentation in vitiligo occurs by progressive loss of melanocytes from the basal layer of the skin, and can be psychologically devastating to patients. T cell-mediated autoimmunity explains the progressive nature of this disease. Rather than being confronted with periods of rapid depigmentation and bouts of repigmentation, patients with long-standing, treatment-resistant vitiligo can undergo depigmentation treatment. The objective is to remove residual pigmentation in order to achieve a cosmetically acceptable result- that of skin with a uniform appearance. In the USA, only the use of mono-benzyl ether of hydroquinone (MBEH) is approved for this purpose. However, satisfactory results can take time to appear, and there is a risk of repigmentation. MBEH induces necrotic melanocyte death followed by a cytotoxic T cell response to remaining, distant melanocytes. As cytotoxic T cell responses are instrumental to depigmentation, we propose that combining MBEH with immune adjuvant therapies will accelerate immune-mediated melanocyte destruction to achieve faster, more definitive depigmentation than with MBEH alone. Since Toll-like Receptor (TLR) agonists-imiquimod, CpG, and Heat Shock Protein 70 (HSP 70)-all support powerful Th1 responses, we propose that using MBEH in combination with these agents can achieve superior depigmentation results for vitiligo patients.

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A curious case of sweating blood

Cited by 27 publications

References 5 publications

Blood sweat and tears ‐ tackling the stigma of stigmata

Blood sweat and tears ‐ tackling the stigma of stigmata

Hematidrosis on the forehead following trauma: a case report

Enhanced bleaching treatment: opportunities for immune‐assisted melanocyte suicide in vitiligo

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