Blood otorrhea: blood stained sweaty ear discharges: hematohidrosis; four case series (2001-2013).

INTRODUCTION: Hematohidrosis/hematidrosis/hemidrosis is a rare clinical condition in which human being sweats blood under condition of extreme physical or emotional stress [1. Jerajai HR, Bhagyashri Jaju, Phiske MM, and Nitin Lade. Hematohidrosis-a rare clinical phenomenon. Indian J Dermatol. 2009 Jul-Sep; 54(3): 290-292; 2. Martinez NL, Mas IB, Paz AFM, Boronat JL. Recurrent bleeding in an 18-year old girl. Arch Dermatol.2012; 148(8):960-961.] The capillary blood vessels that feed the sweat glands rupture, causing them to exude blood as sweat, under stressful conditions, occurring in religious (Jesus Christ prayer experience in Gethsemane) and non-religious (soldier sweat blood before battle) [2. Martinez NL, Mas IB, Paz AFM, Boronat JL. Recurrent bleeding in an 18-year old girl. Arch Dermatol.2012; 148(8):960-961.]. It is a condition where there is a spontaneous painless bleeding through unbroken skin in any part of the body. It is self-limiting in nature with a good prognosis [3. Patel RM, Mahajan S. Hematohidrosis: A rare clinical entity. Indian Dermatol Online J.2010 Jul; 1(1):30-2.]. The diagnosis of hematohidrosis is made on the presence of bloody discharge without any obvious cause through intact skin, witnessed and confirmed by health professional/doctor/nurse and the presence of blood components on biochemistry studies of the discharge. Hematohidrosis is a well-recognised diagnosis according to International Classification of Diseases (ICD-9-CM: 705-89) (ICD9 Data.com; 2013). CASE REPORT: This study reports the clinical finding, radiology, audiology and histology of four cases of a rare isolated otological hematohidrosis. Our cases are of particular interest because to our knowledge these are the first documented cases of psychogenic hematohidrosis isolated otological (ear) presentation. DISCUSSION: A comprehensive literature review was performed on reports documenting hematohidrosis/hematidrosis cases. The clinical presentation, diagnosis, treatment, pathophysiology and epidemiology of hematohidrosis. The purpose is to report and raise awareness of hematohidrosis among ENT patients.