Abstract
Acquired hemophilia is a rare disease with bimodal age distribution.It carries high morbidity and mortality, especially in elderly patients with other comorbidities. It has a contrasting presentation to congenital hemophilias including large hematomas. There is usually a diagnostic delay due to the rarity of the disease entity necessitating a high index of suspicion. Case presentation: An 82-year-old male with no addictions presented with hematuria and dysuria for 1 week followed 3 days later by ecchymotic patches over his right thigh and right arm. Associated with generalized malaise and anorexia. In the same night, he had multiple episodes of coffee ground vomitus followed by altered sensorium in the form of hypoactive delirium. After intubation, UGIE showed linear ulcers in esophagus and Forrest III peptic ulcers. Neuroimgaing showed watershed infarcts. Sepsis workup showed Candida and Burkholderia spp, and approproate management was institued. Thrombophilia workup showed persistent APTT prolongation, Bethesda assay returned positive for factor VIII deficiency. Hemostasis was achieved with cyropreciptate transfusions and immune suppression was started with rituximab and steorids under high risk. The patient finally succumbed to sepsis secondary to hospital acquired pneumonia. Discussion and way forward: A geriatrician should keep high suspicion of this differential in cases of unexplained bleeding. In our setting, fresh frozen plasma along with cryoprecipitate was used for hemostasis, and it may be considered in resource limited settings. In frail elderly, our case highlighted the age old debate between immune suppression and sepsis.
Details
Presentation Type
Theme
Medical Perspectives on Aging, Health, Wellness
KEYWORDS
Altered sensorium, Acquired, Hemophilia
