9-year-old girl with unusual bleeding.

Abstract

Hematohidrosis, also known as hematidrosis and hemidrosis, is a rare condition in which a human being sweats blood.
Exact etiology  is unknown, believed to be a systemic disease, e.g. it has been associated with vicarious menstruation, a condition in which bleeding occurs from a surface other than  mucous membrane of  uterine cavity at a time when normal menstruation should take place. Hematohidrosis has been reported with primary thrombocytopenic purpura and can  also occur in settings of excessive exertion, psychogenic and other unknown factors.Etiopathogenesis according to Dr. Frederick Zugibe is that multiple blood vessels which are present in a net-like form around  sweat gland, constrict under pressure of stress. As  anxiety increases,  blood vessels dilate to the  point of rupture. Blood goes into  sweat glands, which push it along with sweat to the surface, presenting as droplets of blood mixed with sweat.  A 9/female,born out  of non consagineous marriage, came with  bleeding from intact skin from various parts of body since 15 days. Her first episode of bleeding was 6 months ago which had resolved spontaneously.Her last episode was15 days ago, after which the episodes happened daily.There was  no history of prior trauma or physical/ mental stress, similar complaints in past/family. Cutaneous examination revealed no active lesions. Presence of blood was photographically documented by relative.  Routine blood invesigation  and psychiatric evualtion was normal. Benzidine test, confirmatory for hemathidrosis was positive. There was significant reduction in bleeding episodes after  treatment with tab Propanolol 10 mg in divided doses.
Unique and rare case of haematohidrosis, probably youngest from India, (literature mentions case reports in 11 and13 year old ) is highlighted.