A case of acquired hemophilia A diagnosed after percutaneous endoscopic gastrostomy.
A 65-year-old male with no personal or familial history of bleeding disorders underwent percutaneous endoscopic gastrostomy (PEG) for neurogenic dysphagia due to subarachnoid hemorrhage. On postoperative day 6, continuous oozing of venous blood was observed at the stoma. Prothrombin time was within normal range, but activated partial thromboplastin time was prolonged. Cross-mixing test results indicated the existence of an inhibitor, and laboratory findings revealed decreased factor VIII activity and high levels of factor VIII inhibitor. The patient was diagnosed as having acquired hemophilia A, for which steroid monotherapy was effective. Acquired hemophilia A is a rare but potentially fatal disease. Clinicians should be aware of this condition in patients presenting with sudden hemorrhage after PEG or other endoscopic treatments, even in those with no apparent history of bleeding.
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. 11mh005f@shinshu-u.ac.jp.
Takuma
T
Okamura
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Michiharu
M
Komatsu
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Akihiro
A
Ito
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Tetsuya
T
Ito
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Tomoaki
T
Suga
Endoscopic Examination Center, Shinshu University Hospital, Matsumoto, Japan.
Norikazu
N
Arakura
Department of Hematology, Shinshu University School of Medicine, Matsumoto, Japan.
Hitoshi
H
Sakai
Department of Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Eiji
E
Tanaka
D000368:Aged; D003680:Deglutition Disorders / Q000601:surgery; D005774:Gastrostomy / Q000009:adverse effects*; D006467:Hemophilia A / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D019106:Postoperative Hemorrhage / Q000150:complications; D011239:Prednisolone / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D011239:Prednisolone
Acquired hemophilia A; Endoscopic therapy; Factor VIII inhibitor; Immunosuppression; Percutaneous endoscopic gastrostomy