A Curious Case of Sweating Blood
A 12-year-old girl visited us with a history of bleeding from the intact skin over the forehead, scalp, cheek, nose, and trunk [Figures and ] for the last 2 years. The bleeding occurred in episodes, once or twice a day, sometimes more frequently, especially on waking up in the morning. No preceding history of stress or anxiety and no preceding episode of tingling sensation were found. Each episode started with mild watery secretion over the forehead or other body parts, followed immediately with bright-red colored secretion. Each episode lasted for about 10-15 min, and the patient remained perfectly alright during the post-episode period until the next episode. There was no history of bleeding from any other site. No history of ingestion of any anticoagulants, dyes, or other drugs was obtained from her. She did not have any history of major medical or surgical illness in the past. No family member had similar complaints. Menstrual cycles were regular and normal.\nHer general physical examination and systemic examinations did not reveal any abnormality. The skin over the forehead was normal. There was no local tenderness. Blood or red colored secretion could not be extruded on manipulation. On gross examination, the secretion was bright-red in color, less viscous than blood, and it was not frank blood. On collection of the secretion and examination of its smeared preparation under a microscope, plenty of erythrocytes were observed; the sample was benzidine test positive [] and alkaptonuria negative. Her routine hemogram, blood counts, platelet count, bleeding time (2 min), clotting time (3 min 30 sec), active partial thrombin time (25 sec; normal range 24-32 sec), prothrombin time, liver function tests, and renal function tests were within normal limits. Peripheral smear of the secretion showed multiple red blood cells (RBCs) along with numerous gram-positive cocci and bacilli []. Urine and stool examination did not reveal erythrocytes or any abnormalities.\nPsychiatric analysis revealed Intelligent Quotient (I.Q.) between 60 and 70 and a loss of insight. Histopathological examination revealed no abnormalities in blood vessels and intact walls. Hair follicles, sweat glands, and sebaceous glands are normal. Direct immunofluorescence study ruled out vasculitis.\nThe patient was given atropine transdermal patch over the involved sites and she noticed gradual improvement in both the severity and frequency of the episodes. Gradually, after 1 month, the patient stopped getting similar episodes. We followed the patient for 2 months after stopping the atropine treatment. During this period, she did not have any more episode.