Clinical communication
Acquired factor VIII inhibitor presenting as a tongue hematoma

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Abstract

Acquired hemophilia is a rare disorder that has potentially disastrous consequences if not recognized and treated in the setting of acute hemorrhage. We report a case of undiagnosed acquired hemophilia due to factor VIII inhibitor in which a tongue hematoma was the chief manifestation. Diagnosis, acute management, and long-term therapeutic options are reviewed.

Introduction

Emergency physicians frequently encounter patients with life threatening bleeding and occasionally need to treat patients with bleeding and underlying coagulopathy. Acquired hemophilia, although a relatively rare disorder, may result in devastating consequences for a patient with acute hemorrhage if unrecognized and untreated. We report a case of undiagnosed acquired hemophilia due to factor VIII inhibitor and review the diagnosis, acute management and briefly summarize long term management options.

Section snippets

Case presentation

A 74-year-old African-American woman presented to the Emergency Department (ED) with swelling of the tongue extending into the neck of 3 days duration (Figure 1). The patient had difficulty swallowing and could not speak clearly but denied respiratory distress. There was no history of trauma. The past medical history was significant for hypertension and asthma. The past surgical history included a nasal polypectomy as a teenager, total abdominal hysterectomy in her 30s, and right hip

Discussion

Acquired hemophilia is a rare disorder associated with potentially serious bleeding complications. The incidence is estimated to be 1 per million persons per year (1). In contrast to congenital hemophilia, acquired hemophilia is distributed equally between men and women and is most common in persons over 60 years of age. When the disease occurs in elderly patients it has been associated with connective tissue or autoimmune disease, malignancy, asthma, cutaneous disorders, or drugs such as

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There are more references available in the full text version of this article.

Clinical Communications (Adults) is coordinated by Ron Walls, md, of Brigham and Women's Hospital and Harvard University Medical School, Boston, Massachusetts

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