Patient Diagnosed with Acquired Hemophilia A who Developed Intramuscular Hematoma during Comprehensive Rehabilitation after Stroke: A Case Report

Patient Diagnosed with Acquired Hemophilia A who Developed Intramuscular Hematoma during Comprehensive Rehabilitation after Stroke: A Case Report

Acquired hemophilia A (AHA) is a rare but fatal disease that leads to severe bleeding by autoantibodies to endogenous factor VIII. AHA is more prevalent in elderly patients with underlying comorbidities. Pathophysiology and treatment strategies of AHA are quite different from congenital hemophilia A. AHA is difficult to diagnose early unless the clinician understands and suspects the disease. Delayed diagnosis can have devastating consequences, especially for the elderly. The main goals of the treatment are to control bleeding and eradicate autoantibodies using immunosuppressive agents. We report a case of a 76-years-old patient who bruised easily and developed intramuscular hematoma diagnosed with AHA during comprehensive rehabilitation after subacute stroke. Although intramuscular hematomas or bruises are common during stretching exercise, if intramuscular, mucosal, or submucosal bleeding of unexplained causes persists despite low-intensity rehabilitation treatment in an elderly without a personal or family history of bleeding, AHA should be suspected.

Acquired hemophilia A (AHA) is a rare but fatal disease that leads to severe bleeding by autoantibodies to endogenous factor VIII. AHA is more prevalent in elderly patients with underlying comorbidities. Pathophysiology and treatment strategies of AHA are quite different from congenital hemophilia A. AHA is difficult to diagnose early unless the clinician understands and suspects the disease. Delayed diagnosis can have devastating consequences, especially for the elderly. The main goals of the treatment are to control bleeding and eradicate autoantibodies using immunosuppressive agents. We report a case of a 76-years-old patient who bruised easily and developed intramuscular hematoma diagnosed with AHA during comprehensive rehabilitation after subacute stroke. Although intramuscular hematomas or bruises are common during stretching exercise, if intramuscular, mucosal, or submucosal bleeding of unexplained causes persists despite low-intensity rehabilitation treatment in an elderly without a personal or family history of bleeding, AHA should be suspected.