Patient: An 11 year old boy in India
symptoms: The boy’s parents brought him to the hospital after he started bleeding several times from his eyes, nose and ears. These events, which occurred over about a month, began for no apparent reason, caused no pain, and usually stopped on their own within a few minutes.
what happened next: While evaluating the boy, doctors noticed active bleeding from his eyes and ears. However, examination revealed no injuries or structural abnormalities that could explain the bleeding.
Tests showed that his blood counts were normal, as well as levels of von Willebrand factor, a protein involved in blood clotting. Meanwhile, testing of discharge from his eyes and ears confirmed that they did indeed contain blood.
Ultimately, doctors found no evidence of a bleeding disorder, local injury, self-harm or other obvious medical cause for the bleeding. Because the boy’s parents reported that the incidents often occurred during periods of “academic stress, peer pressure, or parental expectations regarding academic performance,” doctors also arranged for a psychiatric evaluation, they explained in a case report.
A psychiatrist interviewed the child and his parents and also made behavioral observations during the consultation. This evaluation supported the idea that academic stress and parental expectations regarding school performance can cause psychological stress.
Diagnosis: Since extensive testing failed to identify a physical cause of the bleeding, doctors concluded that the symptoms were consistent with stress-related hematohidrosis. This is an extremely rare condition in which people sweat or bleed from intact skin or natural pores of the body. The discharge is sometimes called “blood sweat”, although evidence does not suggest the fluid. passes through sweat glands.
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treatment: Doctors treated the boy with propranolol, a beta blocker that can moisten the body fight-or-flight response. They also prepared him to start cognitive behavioral therapyA common form of talk therapy helps him manage stress and develop strategies to deal with academic pressure. Their parents also received counseling, which included guidance on reducing academic pressure and creating a more supportive environment at home.
Within two weeks, the boy’s bleeding incidents greatly reduced. Four weeks after the start of treatment, only occasional, mild episodes were reported. Three months after the start of treatment, he became symptom-free during his normal daily activities. (The case report does not say how long the treatment lasted.)
What makes this case unique: The boy’s doctors wrote in the case report that there were fewer than 50 cases of hematohidrosis recorded in the medical literature. Although this phenomenon has been reported for decades, its exact cause remains uncertain.
One proposed explanation is that intense emotional stress, fear, or psychological trauma triggers rupture of small blood vessels The surrounding sweat glands allow blood cells to seep into the sweat ducts and emerge to the surface of the skin. However, existing research does not necessarily suggest that the secretions come from sweat glands.
The boy’s doctors cautioned that these observations do not prove that psychological stress directly causes hematohidrosis, although several previous reports have linked the condition to stress.
For example, in A 2017 reportDoctors described a 10-year-old girl whose scalp began bleeding after being punished at school and repeatedly criticized at home over her academic performance. Her symptoms eventually disappeared after psychotherapy, medication, and changes in parenting strategies. A Report published in 2022 A 14-year-old boy is described whose bleeding episodes became worse during school examinations and due to anxiety about returning to class. After receiving treatment with stress-management therapy and antidepressants, he stopped experiencing episodes.
The authors of the case report noted that both of these earlier cases also occurred in India and, in general, many documented cases have originated in Asia, particularly India and Pakistan.
Doctors stressed that systematic and structured psychological and psychological evaluations are needed to better understand the underlying mechanisms of this rare condition.
This article is for informational purposes only and is not intended to provide medical advice.
Tetta, VS, Mattaparthy, JK, Siripurapu, YS, Kandukuri, SP, Doddapaneni, DS, and Singh, T. (2026). Hematohidrosis in a young boy temporally associated with psychological stress: a case report. Clinical Medicine Insights: Case Reports, 19. https://doi.org/10.1177/11795476261446756
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