A 21-year-old woman was admitted to hospital with an extremely rare condition that causes her to sweat blood from her face and the palms of her hands.
Italian doctors were left puzzled after the unnamed patient appeared with the bizarre symptoms despite not showing any sign of skin lesions.
Medics said there was no obvious trigger for the spontaneous bleeding, which could happen while she slept or carried out physical activity.
Her bleeding was most intense when she felt stressed, it was reported in the Canadian Medical Association Journal (CMAJ).
Doctors in Florence report that the patient had suffered the unusual symptoms for the past three years and episodes last between one and five minutes
The woman has reportedly become depressed and socially isolated because of the condition.
Doctors ruled out that she wasn't faking it and tests revealed her blood count and blood-clotting functions were normal.
They eventually diagnosed her with hematohidrosis, which is thought to affect just one in 10 million people.
She was treated her with propranolol – a beta-blocker medication which substantially reduced her symptoms but has not completely stopped them.
The condition is real
It's so rare that many people – including doctors – don't know it exists or if it's real.
Canadian medical historian and hematologist Jacalyn Duffin, who wrote a commentary that accompanies the journal article, revealed she was at first skeptical and suspected the Italian doctors had been duped.
But after exhaustively examining the medical literature she changed her view.
Not much is known about its cause, but it's thought to be a result of extreme stress or fear.
According to a study published in the Indian Journal of Dermatology, the many blood vessels which surround the sweat gland constrict, or narrow, under the pressure of stress.
As the anxiety increases, the blood vessels dilate to the point of rupture. The blood goes into the sweat glands, which push it along with sweat to the surface, presenting as droplets of blood mixed with sweat.
Medical literature makes reference to Leonardo Da Vinci describing a soldier who sweated blood before battle and Jesus experienced hematohidrosis while praying in the garden of Gethsemane before his crucification.
MailOnline reported in May on another case of a young girl who bleeds from her eyes, nose, ears and skin every time she gets a headache.
Phakamad Sangchai , 7, from Nongkghai, Thailand, started profusely bleeding almost six months ago before then.