title: [Ischemic colitis following the treatment of acute hemorrhage in a patient with acquired hemophilia A].
abstract: A 66-year-old man with hypertension and hyperlipidemia developed a hemorrhagic stomal ulcer and massive hematoma of the face at 4 and 7 months, respectively, after fundusectomy for early gastric cancer. The diagnosis of acquired hemophilia A was made based on the marked prolongation of activated partial thromboplastin time, an extremely low factor VIII activity, and a very high-titer factor VIII inhibitor. After admission, oral prednisolone and cyclophosphamide were started. In addition, activated prothrombin complex concentrates and recombinant activated factor VII were intravenously administered which successfully controlled his hemorrhage. Only 1 week after the episode of bleeding, however, he complained of abdominal pain accompanied by watery stool with fresh blood. The diagnosis of ischemic colitis was made based on the clinical course and the findings on both CT-scan and colon fiberoscopy. The colitis spontaneously and quickly resolved with conservative observation. To the best of our knowledge, this is the first reported case of ischemic colitis that occurred in an acquired hemophilia patient without simultaneous administration of coagulation factors or antifibrinolytic agents. We should thus pay attention to the possible occurrence of thrombotic events even in acquired hemophilia patients in the presence of risk factors for thrombosis.
authors.affiliation: Department of Hematology, Tokyo Medical and Dental University.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Ayako
authors.initials: A
authors.lastname: Arai
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Koyama
authors.forename: Gaku
authors.initials: G
authors.lastname: Oshikawa
authors.forename: Masahide
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Mizuchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kurosu
authors.forename: Shuji
authors.initials: S
authors.lastname: Tohda
authors.forename: Naomi
authors.initials: N
authors.lastname: Murakami
authors.forename: Tohru
authors.initials: T
authors.lastname: Miki
authors.forename: Osamu
authors.initials: O
authors.lastname: Miura
mesh_terms: D000208:Acute Disease; D000368:Aged; D017091:Colitis, Ischemic / Q000209:etiology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005167:Factor VII / Q000008:administration & dosage; D005169:Factor VIII / Q000032:analysis / Q000037:antagonists & inhibitors; D015942:Factor VIIa; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000008:administration & dosage; D013274:Stomach Neoplasms / Q000601:surgery
chemical_list: D011994:Recombinant Proteins; D003520:Cyclophosphamide; D005167:Factor VII; D005169:Factor VIII; D011239:Prednisolone; C103587:recombinant FVIIa; D015942:Factor VIIa