title: Mysterious bruises.
abstract: A 69-year-old man presented with multiple spontaneous bruises in the past 2 weeks. Several large-sized hematomas were found on examination. The initial investigation revealed a prolonged activated partial thromboplastin time (aPTT) with normal platelet count and international normalized ratio. Further investigation revealed a low factor VIII activity secondary to presence of factor VIII inhibitor, making the diagnosis of acquired hemophilia A. Further work-up revealed that pernicious anemia was present and acted as an associated disease. After steroids therapy, his aPTT was normalized and the factor VIII inhibitor titer became undetectable. 2 months later, a relapse occurred and new hematomas appeared at his retropharyngeal space and left arm. His bleeding was controlled by administration of recombinant factor VIIa, and a combined therapy of intravenous steroids and rituximab was given to eradicate the inhibitor. The approach to workup of bleeding disorders as well as treatment of acquired hemophilia A are herein discussed.
authors.affiliation: Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA.
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.forename: J
authors.initials: J
authors.lastname: Jiao
authors.forename: C P
authors.initials: CP
authors.lastname: Cheung
authors.forename: S
authors.initials: S
authors.lastname: Borra
mesh_terms: D000368:Aged; D003288:Contusions / Q000209:etiology*; D003937:Diagnosis, Differential; D006467:Hemophilia A / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010314:Partial Thromboplastin Time; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents