Blood otorrhea: Blood stained sweaty ear discharges: Hematohidrosis; four case series (2001–2013)
Introduction
Hematohidrosis [[1], [2], [3]] is an excretion of blood or blood pigments in the sweat according to Stedman’s Medical dictionary, an observation by Aristotle “some sweat with a bloody sweat” (Hist. Animal 111, 19) [4]. The reported cases of hematohidrosis appeared to be associated with a severe anxiety reaction with fear implicated as the inciting factor. Cases of hematohidrosis have been reported in the French literature by Broeg in 1907 and by Darier in 1930; in the British literature in 1918 by Scott, in the German literature by Riecke in 1923, and in the Russian literature by Lavsky in 1932 and by Gadzhiev and Listengarten in 1962 [4], [5].
Hematohidrosis is a rare condition, of unknown aetiology (sweating blood). Hematohidrosis is actually a medical condition in which extremely high blood pressure causes blood to seep into sweat glands and escape through pores—illusion of sweating blood [5]. Vasculitis has also been postulated as a cause of hematohidrosis [5], [6]. It is a condition where there is a spontaneous bleeding through unbroken skin in any part of the body [5]. The diagnosis is made by observation of red blood corpuscles (erythrocytes) and other blood components, with no other blood or physical abnormalities found to account for the phenomenon. The documented by attending doctor/physician or any other reliable medical personnel of bloody ear discharges [6], [7].
There were no recent literature reports noted of isolated otological hematohidrosis cases, to our knowledge we are reporting the first case series of psychogenic isolated otologic hematohidrosis.
After my oral presentation entitled “I sweat blood—bloody otorrhea” in our scientific national ENT congress 2003, no one believed my story. Since 2001 my interest has always been high on bloody otorrhea, hematohidrosis. I received 3 other cases communicated to me by another ENT specialist, with similar presentation. In this community of Gauteng province (RSA) in Africa. We present four case series since 2001–2013 confirmed by four different senior ENT specialists with similar history of blood stained otorrhea under severe stress with no obvious pathological cause, normal intact tympanic membrane and ear canal. It is possible that other specialists are seeing this phenomenon. This report is written to document and raise an awareness of hematohidrosis among ENT patients.
Section snippets
Patient 1: 2001–2003
A 30 year old married Black lady, a lawyer by profession, presented with intermittent bilateral spontaneous painless non-clotting bloody discharge from both ears. The episodes lasted for 15–20 min with 2–5 ml blood stained discharges from each ear per an attack, 2–3 attacks in a week in every 3–4 month interval a total of 8 episodes since 2001–2003. In the end of 2001 she got married, was appointed to a very demanding senior management position in a private company and was a part-time MBA
Disscusion
All our patients presented with similar clinical history of sweaty bloody ear discharges without any clear pathological cause. There are three classification types of hematohidrosis identifiable: Vicarious menstruation, Excessive physical exertion, Psychogenic and unknown types [4], [5].Among the cases described it is more common in females mainly from the western hemisphere. The Caucasian race predominates and it may be due to the number of cases of vicarious menstruation [5].
A vast number
Conclusion
We are reporting the first cases from South Africa of isolated recurrent otological spontaneous, sporadic hematohidrosis (bilateral painless bloody otorrhea) not associated with menstruation but with severe psychogenic stresses. Management is supportive therapy, reassurance and close observation until spontaneous resolution takes place, this promotes early resolution of the psychogenic sporadic hematohidrosis and wellbeing of the patient. These cases confirm the existence of hematohidrosis in
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