Very rare condition causes 11-year-old boy to bleed from eyes, nose and ears, linked to severe stress

An unusual clinical case in India revealed that an 11-year-old boy began to experience spontaneous bleeding from his eyes, nose and ears. The disturbing episodes caught the attention of the medical community and parents.

As detailed in the prestigious journal Sage Journals, occurrences of bleeding appeared without any visible cause. Surprisingly, there was no report of pain from the child, and the episodes usually ended within a few moments.

After more than a month of these inexplicable manifestations, the boy’s parents sought emergency care. However, the first tests carried out by health professionals were unable to identify the exact origin or reason for the bleeding condition.

This condition, considered ultra-rare, is commonly confused with self-mutilation or other hematological disorders.

Despite laboratory confirmation of the presence of blood in the secretions, the results of the blood count tests and the boy’s von Willebrand factor levels were within normal limits, which made the initial diagnosis difficult.

Finally, the diagnosis was made of hematidrosis, popularly known as ‘bloody sweat’. This is a rare condition where the body spontaneously secretes blood or a liquid with traces of blood, through sweat glands and other mucous membranes, including the mouth, nose, ears, tear ducts and even nipples.

Identification of hematidrosis is admittedly challenging, as its symptoms can be confused with conditions such as self-mutilation, Munchausen syndrome or other conditions linked to blood clotting, such as von Willebrand disease, which impacts the formation of clots.

This pathology is considered very rare, with less than 50 occurrences described in the global medical literature. Despite the low incidence, researchers emphasize that the symptoms tend to be more present in adolescents, especially in Asian communities such as those in India and Pakistan.

Interestingly, most cases of hematidrosis — around 84% of patients — are observed in females, making the boy’s case even more peculiar.

It is observed that hematidrosis attacks are often linked to situations of great emotional or psychological stress.

In the context of this specific case, the boy’s parents noticed a clear correlation between the bleeding and a combination of factors: stress related to studies, social pressure from peers and parental expectations about his school performance.

Due to this finding, the boy and his guardians underwent a complete psychological assessment, carried out at different times from the bleeding crises.

Parents’ observations were crucial in associating the bleeding with a triad of stressors: academic pressure, peer influence and family demands regarding academic performance.

The psychiatrist in charge of monitoring focused on the precise identification of emotional triggers, behavior patterns and elements of psychosocial stress that manifested themselves in each bleeding episode.

During the sessions, the boy himself described feeling intense anxiety, directly linked to his performances at school and the perception of strong parental pressure to achieve good results.

The conclusions were based on behavioral observations carried out during the sessions, the young people’s own statements and detailed interviews with their caregivers.

Subsequent treatment included giving the boy propranolol, a drug in the beta-blocker class. Its function is to mitigate the body’s ‘fight or flight’ reaction, helping to reduce anxiety levels.

Simultaneously, the patient began follow-up with cognitive-behavioral therapy. The objective was to provide young people with skills to manage their emotions, incorporate relaxation methods and develop effective strategies to face the pressure required by the academic environment.

The boy’s hemorrhagic manifestations began without any discernible reason, did not cause pain and tended to disappear within a short period of time.

Furthermore, the minor’s parents were included in counseling sessions. The intention was to reduce the emphasis on demanding high performance and build a more welcoming home, thus minimizing potential factors that could trigger crises.

Just two weeks after initiating medical and therapeutic interventions, a significant reduction in bleeding episodes was noted.

Four weeks after treatment, the boy reported only a few mild manifestations. Within a period of three months, the frequent bleeding had completely stopped.

The researchers involved in the study highlight that a quick and correct diagnosis of hematidrosis is essential to avoid carrying out unnecessary tests and applying treatments that would not bring positive results.

The team expresses the hope that this case will serve to shed more light on this unusual condition. The aim is to prevent future patients and their carers from experiencing extensive investigations, inappropriate interventions and unnecessary anxiety.

As the authors of the work concluded, “This case highlights the relevance of identifying hematidrosis as a rare clinical condition where psychosocial factors may have a significant contribution, and highlights the importance of a multidisciplinary approach to obtain positive outcomes.”