[Acquired hemophilia complicated with multiple muscle abscess by Nocardia].
An 82-year-old man was referred to our hospital because of bilateral leg swelling and ecchymosis. A hemostatic study showed prolonged aPTT, <1% factor VIII coagulant activity, and a high titer (30.4 Bethesda Units/ml) of factor VIII inhibitor. The diagnosis of acquired hemophilia A (AHA) was made, and treatment with prednisolone (PSL) was started. Within one month of treatment, the hemorrhagic symptom disappeared, aPTT levels returned to normal, and his factor VIII inhibitor was eradicated; however, factor VIII inhibitor was detected again when PSL was decreased to 10 mg/day. We then added cyclosporine A (CyA) to PSL as a second line salvage therapy. CyA therapy resulted in the resolution of AHA with marked and prolonged efficacy; however, hot, red tumors appeared in his right arm and left thigh. Needle aspiration of the tumors revealed muscle abscess, and Nocardia brasiliensis was isolated. We started treatment with sulfamethoxazole-trimethoprim, and the abscess healed promptly without recurrence.
Yamanouchi
Jun
J
Department of Bioregulatory Medicine, Ehime University Graduate School of Medicine.
Abe
Tamami
T
Azuma
Taichi
T
Narumi
Hiroshi
H
Fujiwara
Hiroshi
H
Yakushijin
Yoshihiro
Y
Hato
Takaaki
T
Yasukawa
Masaki
M
D000038:Abscess / Q000150:complications* / Q000628:therapy; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009135:Muscular Diseases / Q000150:complications* / Q000628:therapy; D009617:Nocardia Infections / Q000150:complications* / Q000628:therapy; D009894:Opportunistic Infections / Q000150:complications* / Q000628:therapy; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D016879:Salvage Therapy; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D016572:Cyclosporine; D011239:Prednisolone