Haematohidrosis in a Young Boy Temporally Associated With Psychological Stress: A Case Report

Abstract

Haematohidrosis is an exceptionally rare and poorly understood clinical phenomenon characterized by the spontaneous excretion of blood through intact skin or natural orifices, with episodes often reported in association with extreme emotional or psychological stress. Owing to its rarity, the condition often poses significant diagnostic challenges and may be misinterpreted as a bleeding disorder, self-inflicted injury, or factitious illness. We report the case of an 11-year-old boy who presented with a 1-month history of recurrent, painless, self-limiting episodes of bleeding from the eyes, nose, and ears. These episodes were temporally associated with periods of academic and parental stress. Comprehensive hematological, biochemical, and radiological investigations, including coagulation studies and von Willebrand factor assays, were within normal limits, effectively excluding systemic or inherited bleeding disorders. Cytological examination and a positive benzidine test confirmed the presence of blood in the secretions. A temporal association between psychosocial stressors and symptom onset was observed. The patient was managed with propranolol to attenuate sympathetic hyperactivity and cognitive behavioral therapy aimed at stress management and coping strategies. This case highlights the importance of recognizing haematohidrosis as a rare clinical condition in which psychosocial factors may play a contributory role, and emphasizes the role of multidisciplinary management to achieve favorable outcomes.