title: Severe recurrent achalasia cardia responding to treatment of severe autoimmune acquired haemophilia.
abstract: Acquired haemophilia A and severe acquired achalasia are both very rare conditions with unknown aetiology. Haemophilia A is a haemorrhagic disease induced by deficiency or malfunction of coagulation factor VIII. Congenital haemophilia is an inherited disease transmitted by the mother through X-linked inheritance and primarily affects males. However, acquired haemophilia A is a serious, sudden-onset, autoimmune disease that affects either sex. In addition, achalasia is a disease of the oesophagus caused by abnormal function of the nerves and muscles. It causes swallowing difficulties due to the inability of the lower oesophageal sphincter to relax during swallowing, leading to dysphagia, regurgitation and chest pain. In this report, we describe the case of a patient with severe, newly diagnosed, acquired haemophilia A with long-standing, recurrent achalasia; the achalasia had recurred 3 times despite complete and proper surgical fixation. Acquired haemophilia A is treated with immunosuppressive therapy. High-dose steroid therapy was administered for 7 months, during which the patient responded well; moreover, the achalasia did not recur for more than 2 years. The response of the achalasia to immunosuppressive therapy suggests that achalasia may be an autoimmune disorder and that there may be an association between both diseases. The findings of the present case suggest that achalasia may favourably respond to steroid therapy as a first-line treatment prior to surgery.
authors.affiliation: Amiri Hospital, Kuwait City, Kuwait.
authors.forename: H
authors.initials: H
authors.lastname: Al-Jafar
authors.forename: M
authors.initials: M
authors.lastname: Laffan
authors.forename: S
authors.initials: S
authors.lastname: Al-Sabah
authors.forename: M
authors.initials: M
authors.lastname: Elmorsi
authors.forename: M
authors.initials: M
authors.lastname: Habeeb
authors.forename: F
authors.initials: F
authors.lastname: Alnajar
keywords: Autoimmune acquired haemophilia; Cross-reacting autoantibodies; Recurrent achalasia cardia