Bleeding from the eyes and through intact skin: Physiologic, structural, spiritual, or faked?

Abstract

Patients with an apparent bleeding disorder can usually be diagnosed by a careful history, physical examination, and screening laboratory tests. However, at times the constellation of bleeding signs and symptoms fail to be explained by test results and/or our current understanding of hemostatic mechanisms. One such patient is the subject of the current report. She is a 13‐year‐old female with a history of striking bleeding manifestations, including spontaneous hemorrhage from her eyes, scalp, hands, and feet. She was evaluated by one of the authors at a teaching hospital in Mumbai, India in March 2009 during the filming of a National Geographic Channel documentary characterizing puzzling medical disorders encountered in India. Given her unusual bleeding manifestations, she received international media attention at the time. National Geographic and a film company in the United Kingdom subsequently expressed interest in highlighting the patient to document her seemingly rare hematologic disorder and contacted the American Society of Hematology to identify an American hematologist to further investigate the case. With consent of the family and collaboration with a hematologist practicing at a teaching hospital in Mumbai, filming commenced during March 2009 in an attempt to capture the patient's diagnosis and the cultural and medical milieu in which the bleeding events occurred. Am. J. Hematol. 88:713–716, 2013. © 2013 Wiley Periodicals, Inc.

Religious stigmata: a dermato‐psychiatric approach and differential diagnosis

“…Exudate and patient blood grouping is also a helpful tool to point out the origin if they turned out to be identical . Chromatidrosis, pseudochromatidrosis, self‐injury, congenital or acquired hemostatic disorders, and anatomical/vascular lesions should be carefully ruled out …”

“…Factitious disorder on the other hand is also a conscious and voluntary fabrication or exaggeration of physical and/or psychological symptoms but differs from simulation in that it serves an internal gain (i.e., assuming the sick role, getting medical attention, and seeking investigatory and therapeutic procedures) …”

“…It is the perpetrator, not the victim, that receives the diagnosis . The caregiver in question is most frequently the person's mother, presenting as remarkably concerned by her child's case, making it hard to suspect that the infant is subject to abuse . The term “dermatitis artefacta” has been used to refer to either simulation or factitious induction of skin symptoms…”

“…The inability of the evaluators to observe the onset of the bleeding constitutes the major obstacle of most of the work encountered in the medical literature, as both simulation and factitious disorders could not be ruled out. For example, in one study, Bezner et al . report the case of a 13‐year‐old Indian girl who presented with bleeding from the eyes and through intact skin, with no obvious emotional stress, neither before nor during her bleeding spells.…”

“…report the case of a 13‐year‐old Indian girl who presented with bleeding from the eyes and through intact skin, with no obvious emotional stress, neither before nor during her bleeding spells. However, as the authors explain, the inception of these spells was never directly witnessed by a member of the medical staff but only by the mother, which raises the question of both factitious disorder and factitious disorder by proxy …”