Acute onset dysphagia associated with an intramural oesophageal haematoma in acquired haemophilia.
A 78-year-old man presented with a 5-day history of epistaxis and spontaneous bruising, and a 2-day history of acute dysphagia. Barium swallow, computerized tomography scan of the chest and upper gastrointestinal endoscopy were suggestive of an upper oesophageal tumour, although biopsies failed to confirm this. Investigations including a raised activated partial thromboplastin time led to the detection of an inhibitor causing functional factor VIII deficiency. Following treatment with intravenous human immunoglobulin, oral prednisolone and oral cyclophosphamide, the patient's dysphagia resolved. There was a resolution of the findings seen at the initial endoscopy and on computerized tomography scan of the chest, consistent with an oesophageal haematoma. Follow-up endoscopy failed to detect recurrence or an aetiological factor.
Horan
Paul
P
Department of Gastroenterology (Level 6), Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK.
Drake
Mary
M
Patterson
R Neil
RN
Cuthbert
Robert J G
RJ
Carey
Declan
D
Johnston
Simon D
SD
D000208:Acute Disease; D000368:Aged; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D004935:Esophageal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging; D006467:Hemophilia A / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed