Crimson Tears: A Rare Case of Hematohidrosis

Abstract

Hematohidrosis is a rare clinical disorder characterized by oozing blood from intact skin and mucous membranes in the absence of a bleeding disorder. Most of the cases reported are from Asia. Although etiopathogenesis is unclear, it has been strongly linked to psychological stress. A nine-year-old girl was brought to the hospital with multiple episodes of painless bleeding from her nose and mouth for four days and eyes for three days, lasting four to five minutes each. Her symptoms and a thorough but unrevealing workup, including brain imaging, led to a clinical diagnosis of hematohidrosis, with parental disharmony as the underlying stress factor. Family therapy was recommended, and parent management training regarding the positive and negative reinforcement techniques was given. A significant improvement was observed at her one-month follow-up. This case adds to the current limited literature on hematohidrosis, highlighting its association with psychological stress and the importance of a multidisciplinary approach to management. Future research is warranted to elucidate molecular pathways involved in stress-induced vascular dysfunction and explore targeted therapeutic interventions.

Keywords: bleeding episodes; eccrine sweat glands; hematohidrosis; multidisciplinary team; pediatric hematology; pediatric psychiatry; stress-induced.

Figure 1. Photograph of the patient showing bleeding from the corner of her mouth

Figure 2. Photographs of the patient showing bleeding from the eyes

2A: bleeding from the left eye, 2B: bleeding from both eyes