Michael Spann was coming down the stairs of his home the first time he cried blood.
The bleeding came with a sudden flash of pain.
"I felt like I got hit in the head with a sledgehammer," said Spann, who lives in Antioch, Tenn. "I never felt anything like it."
He doubled over, holding his head. The expression on his mother's face told him something was wrong.
Blood was streaming from his eyes, nose and mouth - a scenario that began to occur daily when he was 22. Almost seven years later, the bleeding occurs less frequently - about once or twice a week. The headaches have never gone away. Spann wants to know why he bleeds - an answer that he may never get.
Doctors have been unable to determine a cause, he said. A neurologist at the Cleveland Clinic told him he had a very rare idiopathic condition, a disease without an apparent cause. He wonders just how rare the condition is, especially since a teenager from East Tennessee with similar symptoms was the subject of news stories four years ago.
Dr. James "Chris" Fleming, an ophthalmologist at the University of Tennessee Health Science Center's Hamilton Eye Institute in Memphis, thinks the condition may not be as rare as some doctors think. He and colleagues detailed seeing four patients with bloody tears of an unknown cause over an 11-year period in a 2004 article published in a medical journal. It was the first account of idiopathic cases since 1935.
"Most of these were relatively young patients," Fleming said. "As they matured, the bleeding decreased, subsided and then stopped."
Calvino Inman, a Rockwood, Tenn., resident shared his story in 2009 about a condition in which blood flows from his eyes.(Photo: The University of Tennessee Health Science Center)
Doctors are hampered at pinpointing a cause because exploratory procedures can do more harm than good, he said.
"There probably is a cause, but it is a small tear duct that is only a millimeter or two or three in diameter," Fleming said. "It's a tube. To get into that tube and examine that tube from one end to the other would cause scarring, and you could lose part of the tear duct. That's the dilemma that can cause problems, that we will leave someone with a permanent disability."
The condition is already disabling in many ways for Spann. It has kept him from working or attending college. And it has made him reclusive.
"I have kids that ride by on bikes in this neighborhood who point and say, 'That's the guy who bleeds,'" he said, explaining why he did not want his face pictured in The Tennessean. "I really don't want more than that."
He tried working construction.
"Any job I get I lose because my eyes start bleeding and they can't keep me on," Spann said. "Obviously, I can't be a waiter and work in any public thing because you are bleeding."
He said he was in good health when the episodes began.
"He will start talking to someone, and his eyes will start filling up with blood," said his mother, Peggy Spann. "They haven't seen it before, and it will scare the living daylights out of them. It is very frustrating not to be able to treat or even get some kind of remission for it."
Attempts to diagnose his condition have been somewhat limited because he's without health insurance. He's been to three local emergency rooms, he said. His family scraped up the money for two visits to the Cleveland Clinic after a Nashville doctor recommended a neurologist there who specializes in headaches.
He underwent $4,300 worth of lab work there, but doctors could not determine a cause, Peggy Spann said. She reached out to The Tennessean seeking a news story that might generate answers for her son.
Another person from Tennessee, Calvino Inman, shared his story on talk shows in 2009 in hopes of finding a treatment or cure. He was 16 at the time and lived in Rockwood in East Tennessee. The Spanns have tried unsuccessfully to make contact with Inman. The Tennessean could not reach him for comment.
Linking people who have suffered from the condition helps them deal with the social isolation, Fleming said. It's something he has done after receiving permission from patients. Michael Spann plans to send him a letter asking for help.