Hematidrosis or Hematofolliculohidrosis: Report of the Second Case with Complete Histopathologic and Immunologic Studies and a Review of the Literature

Jane Manonukul, MD,¹ Wanee Wisuthsarewong, MD,² Rattanavalai Chantorn, MD,² Ngoentra Tantranont, MD^1
1Department of Pathology and ²Department of Pediatrics, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Conflicts of Interest : All authors have no conflicts of interest.
Corresponding author : Jane Manonukul, MD
Professor of Dermatopathology Department of Pathology Faculty of Medicine
Siriraj Hospital Mahidol University Bangkok, 10700 Thailand
E-mail: jane.man@mahidol.ac.th
Received 29 August 2016; Accepted 15 September 2016

Abstract

Hematidrosis, or bloody sweat, is a rare phenomenon with enigmatic pathogenesis. We present our second case of hematidrosis in a 13-year-old Thai girl that had bloody sweat frequently observed on her back, hands, legs and feet. Skin biopsy revealed areas of hemorrhage in the panniculus and blood-filled spaces in the dermis. These spaces were usually located just under the epidermis and next to hair follicles and eventually they broke the overlying epidermis and adjacent hair follicles, producing bleedings on her skin. We detected continuity between these spaces and areas of hemorrhage in the panniculus. This presence of blood-filled spaces that eventuate in hemorrhage is similar to the findings disclosed in our first report [1]. Thrombosis (without vasculitis) of small capillaries was noted and was proposed as the cause of hemorrhage in hematidrosis.