An 18-year-old woman presented with a 6-month mucocutaneous bleeding from the nose, lacrimal ducts, forehead, hands, nails, and navel. Initially bleeding episodes were infrequent, but increased to several times a day by the time of evaluation. Episodes were spontaneous, self-limited, and immediately preceded by intense headache and abdominal pain. Usually high stress was also present. There was no history of previous illnesses. Physical examination showed no signs of self-inflicted lesions. All laboratory, image, and coagulation tests, including platelet aggregation, were normal. More than 30 bleeding episodes were witnessed during hospitalization and samples of the fluid contained all normal blood cells. A skin biopsy, taken immediately after bleeding, was normal. Treatment with β-blockers was effective. Twenty months after diagnosis the patient has only rare bleeding episodes.
Hematidrosis is a rare phenomenon characterized by blood oozing from skin and mucosa. Although the pathologic mechanism remains unclear, it has been proposed that dermal defects may lead to blood-filled spaces that would exude into follicular canals or directly to the skin surface. The response to propranolol and association of stress with the bleeding episodes suggests the involvement of sympathetic nervous system activation in hematidrosis.
An 18-year-old woman presented with a 6-month mucocutaneous bleeding from the nose, lacrimal ducts, forehead, hands, nails, and navel. Initially bleeding episodes were infrequent, but increased to several times a day by the time of evaluation. Episodes were spontaneous, self-limited, and immediately preceded by intense headache and abdominal pain. Usually high stress was also present. There was no history of previous illnesses. Physical examination showed no signs of self-inflicted lesions. All laboratory, image, and coagulation tests, including platelet aggregation, were normal. More than 30 bleeding episodes were witnessed during hospitalization and samples of the fluid contained all normal blood cells. A skin biopsy, taken immediately after bleeding, was normal. Treatment with β-blockers was effective. Twenty months after diagnosis the patient has only rare bleeding episodes.
Hematidrosis is a rare phenomenon characterized by blood oozing from skin and mucosa. Although the pathologic mechanism remains unclear, it has been proposed that dermal defects may lead to blood-filled spaces that would exude into follicular canals or directly to the skin surface. The response to propranolol and association of stress with the bleeding episodes suggests the involvement of sympathetic nervous system activation in hematidrosis.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visithttp://imagebank.hematology.org.
