Stigmata? Nameless Condition, Mysterious Bleeding

Every decade, people around the globe come forward to claim that they spontaneously bleed and bruise without an injury, disease or chemical to cause it.

Stigmata might first come to mind, but there are many terms for the spontaneous bleeding -- psychogenic purpura, autoerythrocyte sensitization, Gardner-Diamond syndrome -- and just as many different reactions to the claims.

Skeptics, the religious, psychoanalysts and the medical profession have all vied to explain the condition. And those who claim to have the symptoms often report they are mystified and stigmatized and unable to get help.

Take the family of Twinkle Dwivedi, a 13-year-old girl from Lucknow, India, who has spent the better part of a year asking doctors for a physical explanation to her unusual bleeding.

Searching for a Blood Disorder

Dwivedi and her family say she bleeds spontaneously from her mouth, her ears, her eyes, her hairline and the soles of her feet. The bleeding lasts for only a couple of minutes, but it can start five to 10 times a day.

The first time it happened, in July 2007, Dwivedi said she was quietly taking notes in class when blood suddenly started to ooze from her mouth. It happened again a few days later, and eventually the bleeding became a regular problem.

Since then, Dwivedi's family said this painful cycle has threatened her life and completely changed her world: She has lost friends, her chance to be at school, and her family must keep someone at the house with her at all times.

From the beginning, Dwivedi's family went to clinics, then hospitals, then specialty centers just trying to get a diagnosis and some hope of relief.

"I still remember that day very well when Twinkle came to my clinic," said Dr. Pervez Ahmed Siddiqui, Dwivedi's family physician.

"Blood was profusely oozing from her swollen nose and lips. Since she was coming from the school, I thought she might have got injured," he said.

But Dwivedi hadn't been in a school fight, and in the days that followed she returned to his office with more bleeding. She lost so much blood that she spent three days in the intensive care unit.

Siddiqui first referred her to an ear, nose and throat specialist, and then to a local renowned government hospital, the Sanjay Gandhi Postgraduate Institute of Medical Sciences. Finally, Siddiqui sent her to the All India Institute of Medical Science, or AIIMS, in Delhi, one of the best medical institutes in India.

Diagnosing Rare Bleeding

"Doctors over there told her that she has some rare blood disorder but couldn't find a name for that," Siddiqui said.

While doctors at AIIMS could confirm seeing Dwivedi they were bound by hospital privacy rules not to disclose more information without a series of written consent forms.

Dr. Renu Saxena, a professor and head of the hospital's hematology department, told that her team gave Siddiqui a diagnosis. But Siddiqui and the Dwivedi family say they still don't have a diagnosis, or a treatment.

"After almost 1½ years, it's back to square one -- she bleeds every day through her pores," Siddiqui said. All he can do, he said, is give Dwivedi a blood transfusion every two months.

"I feel so helpless and start cursing myself when that poor soul stares at me blankly and asks me whether she would ever get cured," Siddiqui said.

Twinkle Dwivedi, 13, from Lucknow India says she has suffered bleeding from her eyes, hairline, hands and feet.

While Dwivedi and her family view her bleeding as a medical condition so rare that doctors do not understand it, some people who claim to have the same inexplicable bleeding decide not to seek a medical cure.

A Sign, Not a Symptom?

In 1999, the Rev. Zlatko Sudac, a Croatian Roman Catholic priest, claimed he began bleeding from a cross-shaped wound on his forehead, according to a story about his 2002 visit to New York City in New York Magazine.

One year later, Sudac said he also started bleeding on his wrists, feet and side -- all locations associated with biblical accounts of Jesus Christ's wounds during the crucifixion.

Dwivedi also reported bleeding associated with stigmata such as "sweating blood," bleeding from her eyes and bleeding from her hands and feet. But the reaction to Sudac's symbolic wounds was quite different.

The Dwivedi's family reported that people doubted their claims at first, but most came to believe them and either pitied them or avoided the family.

Jeetu Tiwari, a 7-year-old boy who lives nearby, got so frightened the first time he saw Dwivedi bleeding that he ran inside his house. Now his father asks him to stay away.

"It looked like she had injuries all over her head," Tiwari said. "That was quite frightening."

Wounds Attract or Scare Others

While neighbors ran from Dwivedi, local newspapers, such as the New York Daily News reported churches overflowing with people who'd come to see Sudac. Now Web sites devoted to him carry his picture and prayers.

Meanwhile, Sudac was met with equal disbelief and skepticism. He reportedly does not give interviews to the media, and at the time of his visit to New York, even the Catholic Church refused to make any judgment.

The Rev. Zlatko Sudac has drawn crowds to see what he claims to be stigmata wounds on his forehead, hands, feet and side.

"There's no indication he's been anything but a good priest. As far as the stigmata is concerned, there has been no position taken on that," Frank DeRosa, spokesman for the Diocese of Brooklyn and Queens, told the New York Daily News.

While Sudac attributes his bleeding to faith, and Dwivedi is searching for a physical explanation, many top doctors would take an entirely different view: either completely disbelieve it or search for psychological reasons.

Psychosomatic Mystery?

"I was in a clinical center in the [National Institutes of Health] and I saw many, many cases -- they actually can bleed into their skin," said Dr. Louis Aledort, a professor of medicine at Mount Sinai Hospital and a hematologist specializing in bleeding and coagulation disorders.

"I must have seen in my career, 20 patients about this," Aledort said.

Aledort said the causes are debated, but many believe it is a subconscious action of the brain due to trauma. First, the person bruises, even under the protection of a cast, and then rarely, people bleed through the skin.

"They can have spontaneous bleeding into the skin that is controlled by the emotions," Aledort said. "These people are not doing it on purpose and nobody understands how it works, but clearly blood vessels can be controlled by emotions."

In 2000, Turkish doctors reported a case of psychogenic purpura with symptoms similar to stigmata in the May edition of the journal Psychosomatics.

According to the doctors, a 22-year-old widow was admitted to the psychiatry department of Istanbul Medical School by the perplexed hematology department for psychiatric evaluation. She had spontaneous and unexplained bleeding from the eyes, nose, ears and mouth as well as several bruises, especially in the extremities

Psychosomatic Bleeding

"Although bleeding from the eyes is very rare, especially in Western literature, seven cases have been reported in Turkey," wrote Dr. Basak Yucel in the article.

More often than not, the cases of psychosomatic purpura are relegated to bruising under the skin. Some doctors would not even classify these extraordinarily rare cases of bleeding through the skin as the same phenomenon as psychosomatic bruising.

Dr. Michael Bostwick and Dr. Mark W. Imig outline a changing psychogenic purpura (bleeding under the skin) for the Mayo Clinic Proceedings

"The fact that you can produce purpura by thinking about it is real," said Dr. Peter J. Koblenzer, temporary professor at Temple University and a dermatologist Moorestown, N.J.

"It's not manipulation, it's something that really happens, but it does not cause bleeding," he said.

Koblenzer has seen many patients with psychogenic purpura. With one young girl, he did an experiment to see if her mind was having an effect on her mysterious bruises. He took her blood and filled three syringes with it. He told her syringe No. 2 was her blood, and the other syringes had the blood of other people.

"I told her, 'Look, this is a very important test to see what's wrong with you. We think you're allergic to your own blood. We're going to inject that into your leg and you're going to have a big reaction to the No. 2 blood,'" Koblenzer said.

Koblenzer said that all the injections naturally formed bruises. "But the bruise from No. 2 was very much larger than the other bruises. ... He made, somehow, that bruise bigger," he said.

Karen Russo contributed to the reporting of this story.