When someone says they're "sweating blood," it's usually just a metaphor. But for a young woman in Italy, the phrase is disturbingly literal: For the past three years she's had episodes of spontaneous bleeding from her face and palms, with no evidence of cuts, abrasions, or skin lesions. She's been actually sweating blood.
According to a report in the Canadian Medical Association Journal, the patient was 21 years old when she was admitted to a medical ward for the condition, which seemed to have no clear cause. It could happen while she slept, or during physical activity; the most intense bleeding seemed to happen when she felt emotionally stressed. The episodes usually lasted one to five minutes.
The inexplicable bleeding embarassed her, and she reported being socially isolated, with symptoms consistent with major depressive disorder and panic disorder. She had no history of psychosis; doctors at the University of Florence in Italy ruled out "factitious disorder"—a mental disorder in which people fake or exaggerate illness—and even observed blood-stained fluid appear on her face.
With fakery ruled out, they tested her blood and treated her depression with medication. The bleeding continued. Doctors diagnosed her with hematohidrosis, a rare and poorly understood condition marked by "blood sweat" discharged through intact skin. The phenomenon has been noted and commented on for centuries, and various causes have been proposed, from "suppressed menstruation" to an intense emotional reaction to illness—a kind of hysteria.
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An accompanying literature review of hematohidrosis notes that most of the cases have been women, which may have influenced the gendered explanations that arose in the 19th century. Even earlier, though, the author notes, Aristotle described sweat that was (or seemed to be) blood, and scattered "case reports" described men and boys sweating blood under duress. Several writers described the phenomenon in prisoners facing execution.
Intriguingly, more than half the reported cases over the past 100 years happened in the past five years. Since 2004, 28 cases (24 female, 4 male) have appeared in the peer-reviewed literature, hailing from every continent except North America. For females, the average age was just over 14, while men tended to be older, at 26.5 years (though that's from a much smaller group). All had the same basic condition: bloody sweat from apparently normal skin. It's not clear why there's been an apparent rise in cases.
Six of the patients responded to beta-blockers, which is what doctors gave to the Italian patient. That's led to a marked reduction in her bleeding, though not a total remission. Her case is one more in the mysterious history of hematohidrosis.
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