Acquired hemophilia a discovered with a hemorrhagic duodenal ulcer that had difficulty with endoscopic hemostasis, report a case

A 77-year-old woman was admitted to our hospital because of a hemorrhagic duodenal ulcer that had difficulty with endoscopic hemostasis and hemorrhage from right subclavian vein in which was inserted a central venous catheter. Coagulation tests showed a great prolongation of activated partial thromboplastin time (APTT) on admission. After admission, severe bleeding from the ulcer appeared, we performed endoscopic therapy by hypertonic saline-epinephrine injection. Hemorrhage from right subclavian vein was stopped by astriction. Laboratory studies showed an extremely low factor viii activity and the presence of a very high -titer factor viii inhibitor. She was diagnosed as acquired hemophilia A, and treated with oral prednisone, cyclophosphamide and intravenous methylprednisolone pulse therapy. After treatment, activated partial thromboplastin time normalized and factor viii inhibitor disappeared. In case of gastrointestinal bleeding that had difficulty with endoscopic hemostasis, we should pay attention to the possibility of acquired hemophilia A.