The condition reported by an Italian woman prompted experts to investigate, leading them to about two dozen similar cases worldwide in the past 15 years

The case left doctors perplexed: a 21-year-old Italian woman with no gashes or skin lesions arrived at a medical ward, where she described years of sweating blood from her face and the palms of her hands.

The bleeding would often start while she was sleeping or during physical activity and could last anywhere from one to five minutes. While the intensity of the bleeding seemed to increase with stress, she couldn’t single out any obvious trigger.

Her condition has been documented by two physicians from the University of Florence in Italy in the latest issue of the Canadian Medical Association Journal.

The condition – which had begun about three years before she sought medical help – had taken a toll on her mental health, wrote doctors Roberto Maglie and Marzia Caproni. “Our patient had become socially isolated owing to embarrassment over the bleeding and she reported symptoms consistent with major depressive disorder and panic disorder.”

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They prescribed her anti-anxiety medications, but the bleeding continued. After a round of tests and observations ruled out the possibility that she was faking the condition, she was diagnosed with hematohidrosis, a rarely reported condition in which patients spontaneously sweat blood through unbroken skin.

Doctors treated her with propranolol, a heart and blood pressure medication, which reduced the bleeding but failed to eliminate it completely.

Jacalyn Duffin, the Canadian medical historian and haematologist who wrote a commentary that accompanies the report, said she was initially sceptical. “My first thought was, is this real? Could it be fake?” The mystery deepened after she canvassed her senior haematology colleagues and found that not one of them had ever come across such a case.

Duffin then delved into the medical literature, managing to turn up more than two dozen similar cases reported around the world in the past 15 years or so.

In many of these, researchers had carefully documented the tests they had carried out to eliminate the possibility of other bleeding disorders and the evidence they had found to suggest the presence of blood in the sweat ducts. “I came to the conclusion that it’s plausible and that it’s possible,” said Duffin.

The majority of these cases involved young women or children. Many of the reports documented that the bleeding was preceded by emotional trauma, such as witnessing violence at home or at school. In all of the patients, the condition was transient, lasting anywhere from a month to four years.

Little else – from its causes to how to halt the bleeding – is known, said Duffin. Some have hypothesised the condition could be caused by blood coagulation disorders or a rupture of the smaller blood vessels within tissues.

Facebook Twitter Pinterest ‘I began to wonder if one of the reasons journals don’t publish it, or are a little bit leery of it, is because it has kind of been owned by religious sources,’ Duffin said. Photograph: CMAJ

While Duffin found references of the condition stretching back to the writings of Aristotle, the condition – described in one report as a “kind of modern-day stigmata” – is often referenced alongside Christianity and the crucifixion, an association that may make it more difficult to accept, she noted.

“Blood is so pervasive – in not only religious mythology, but all mythology – that it makes people sort of think twice,” she said. “I began to wonder if one of the reasons journals don’t publish it, or are a little bit leery of it, is because it has kind of been owned by religious sources.”

This could be slowly changing. Of the 42 reports Duffin came across, almost half had appeared in the last five years, raising questions as to whether the incidence of the condition is increasing or whether it’s simply becoming more recognised by doctors.

This latest report might also help to shine a spotlight the condition, noted Duffin. She said she had already heard from one man who believed his relative – a returning war veteran with PTSD – might also be afflicted.

“The reason that I think it’s possible that there might be more out there than we know is that it seems that, although it’s spectacular, it’s benign,” she said. “In all of these cases I dug out – the 42 case reports – the patients all survived. They’re terrified because it’s really frightening to have this happen, but it seems to be quite innocuous as a symptom.”