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Unusual bleeding

      A 15-year-old woman presented to the department for recurrent otorrhagia (panel A), bleeding from the nipples, bleeding from the forehead (panel B), bleeding from the navel (panel C) and epistaxis (panel D). She had no previous medical history and no history of bleeding. Clinical examination revealed no skin or vascular lesion, no bruises, and gynecological examination was normal. Multiple imaging remained standard. Laboratory results showed no anomaly, including strictly normal hemostasis, vitamin C and cortisol. Analysis of the fluids showed only normal red blood cells. Bleeding occurred spontaneously, mostly at night, three to four times a day without any trauma, in a context of general anxiety related to school.
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