A 21-year-old woman was admitted to a general medical ward with a three-year history of self-limited episodes of bleeding from her palms and face despite no evidence of skin lesions.
There was no obvious trigger for the bleeding, which could occur while she was asleep and during times of physical activity. She stated that more intense bleeding occurred during times of perceived emotional stress. Episodes lasted from one to five minutes.
Our patient had become socially isolated owing to embarrassment over the bleeding and she reported symptoms consistent with major depressive disorder and panic disorder. There was no history of psychosis.
Our differential diagnosis included factitious disorder and an uncommon condition known as hematohidrosis.