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October 25, 2017

The perplexing case of the woman who sweats blood

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on May 24, 2019.

    Doctors have diagnosed a 21-year-old Italian woman with a rare—and somewhat controversial—illness: hematohidrosis, or "blood sweating," according to a case study published in the Canadian Medical Association Journal.

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    The case study

    According to the case study, authored by Roberto Maglie and Marzia Caproni of the University of Florence, the woman presented for care after experiencing spontaneous bleeding from her palms and face for three years. The bleeding, which would last between one and five minutes per episode, typically occurred after she exercised, when she was stressed, or when she was sleeping.

    Eventually, the condition affected the woman's mental health. According to Maglie and Caproni, the woman "had become socially isolated owing to embarrassment over the bleeding and she reported symptoms consistent with major depressive disorder and panic disorder."

    Perplexed by the case, doctors observed the woman's symptoms and performed blood and skin tests. They determined that she had no lesions or cuts of any kind, and the tests showed that there were no abnormalities that would cause "the discharge of blood-stained fluid" from her skin. 

    Initially, the doctors tried to address the symptoms by treating the woman for depression and panic disorder, but the woman continued to experience bleeding episodes. The doctors eventually diagnosed the woman with hematohidrosis, a rare disease in which blood—similarly to sweat—seeps out of unbroken skin, typically occurring around the ears, eyes, face, or nose. The condition, while benign, is typically associated with emotional trauma, fear, or stress, and it's often transient, lasting between a few months and a few years.

    According to the case study, the woman was given propranolol, a beta-blocker drug usually prescribed to regulate blood pressure and heart rate. While the treatment has led to a "marked reduction" in symptoms, it has not completely stopped the symptoms of her condition, the researchers said.

    Why the condition is under-studied

    In a commentary accompanying the case study, Jacalyn Duffin, a Canadian medical historian and hematologist, said while the condition is rare, it's far from new.

    In fact, the researchers identified 42 previously-reported cases of the disease published between 1880 to 1935 and 1952 to 2016, 18 of which were published within the past five years. A large number of the documented cases involve women, which led researchers involved in some early publications on the topic to suggest that the disease might be connected to menstruation or to mental health conditions in women. Others have suggested the disease could be caused by a blood coagulation disorder or by rupturing small blood vessels underneath the skin.

    But the condition is still largely unexplored, with no identified cause or treatment, and it is occasionally dismissed as a valid diagnosis, Duffin wrote. According to Duffin, that is likely because it has been associated with Christian symbolism, including religious manuscripts suggesting Jesus may have sweat blood before his crucifixion.

    The researchers wrote, "Other rare conditions are not viewed with similar skepticism. … Ironically, for an increasingly secular world, the long-standing association of hematohidrosis with religious mystery may make its existence harder to accept. It seems that humans do sweat blood, albeit far less often literally than metaphorically" (Gilmour, Sacramento Bee, 10/23; Ducharme, TIME, 10/23; Firger, Newsweek, 10/23; Kassam, The Guardian, 10/23).

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