Penicillin-Induced Anti-Factor VIII Antibodies: A Case Report
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Introduction: Acquired hemophilia A is very rare autoimmune disorder caused by an autoantibody to factor VIII that interferes with its coagulant function. It may be associated with a number of conditions such as lymphoproliferative disorders, drugs and solid malignancies. Hemarthrosis in Acquired hemophilia A is very rare clinical presentation and was never reported in cases induced by penicillin.
Case presentation: We report a 65-year-old male, born and living in Brazil, who presented hemorrhagic episodes complicated with joint hemarthrosis due to acquired hemophilia A caused by a commonly used drug, Benzathine penicillin.Disease management was focused on controlling bleeding, primarily with the use of factor VIII inhibition bypassing activity and eradicate the autoantibody using various immunosuppressants. The challenges in manage this case included delayed diagnosis, durable remissions, difficulty achieving hemostasis. Clinical and laboratory coagulation response has improved eight weeks after only with the administration of double immunosuppression medication: corticosteroid and cyclophosphamide.
Conclusion: This case gives us the lesson that prompt diagnosis and treatment achieved by hematologists may improve the prognosis and prevent severe bleeding. Early detection is vital to improving outcomes.
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2. Charlebois J, Rivard GÉ, St-Louis J. Management of acquired hemophilia A: Review of current evidence. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2018;57(6):717-720. doi:10.1016/J.TRANSCI.2018.10.011
3. Maeda K, Yamamoto S, Taniike N, Takenobu T. Acquired hemophilia A that required surgical hemostasis of hematomas occupying oral cavity: a case report. Journal of Medical Case Reports. 2021;15(1). doi:10.1186/s13256-021-02669-w
4. Rinaldi I, Prasetyawaty F, Fazlines S, et al. Diagnosis and Management of Acquired Hemophilia A: Case Reports and a Literature Review. Case reports in medicine. 2021;2021:5554664. doi:10.1155/2021/5554664
5. Gounder K, Batt T, Dreyer M. Two case reports of acquired haemophilia A as complications of alemtuzumab treatment for multiple sclerosis. BMJ neurology open. 2021;3(1):e000095. doi:10.1136/bmjno-2020-000095
6. Rinaldi I, Prasetyawaty F, Fazlines S, et al. Diagnosis and Management of Acquired Hemophilia A: Case Reports and a Literature Review. Case reports in medicine. 2021;2021:5554664. doi:10.1155/2021/5554664
7. Tiede A, Collins P, Knoebl P, et al. International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica. 2020;105(7):1791-1801. doi:10.3324/HAEMATOL.2019.230771
8. Petros S. Pathophysiology of bleeding. Medizinische Klinik - Intensivmedizin und Notfallmedizin. 2021;116(6):475-481. doi:10.1007/s00063-021-00844-x
9. Ma H, Chang H. Life-threatening bleeding in a patient with pemphigoid-induced acquired hemophilia A and successfully treated with rituximab and rFVIIa: A case report. Medicine. 2021;100(3):e24025. doi:10.1097/MD.0000000000024025
10. el Bayed Sakalli H, Matrane W, el Hamzaoui Z, Oukkache B. Acquired hemophilia A: Three cases and review of the literature. Clinical Laboratory. 2019;65(9):1745-1750. doi:10.7754/CLIN.LAB.2019.190140
11. Gardiner C, Hills J, MacHin SJ, Cohen H. Diagnosis of antiphospholipid syndrome in routine clinical practice. Lupus. 2013;22(1):18-25. doi:10.1177/0961203312460722
12. Windyga J, Baran B, Odnoczko E, et al. Treatment guidelines for acquired hemophilia A. Ginekologia polska. 2019;90(6):353-364. doi:10.5603/GP.2019.0063
13. Entrena Ureña L, Fernández Jiménez D, Gutiérrez Pimentel MJ. Treatment and complications in acquired hemophilia A. Experience from a single center. Medicina Clinica. 2017;149(10):457-459. doi:10.1016/j.medcli.2017.08.002
14. Roy AM, Siddiqui A, Venkata A. Undiagnosed Acquired Hemophilia A: Presenting as Recurrent Gastrointestinal Bleeding. Cureus. 2020;12(9):e10188. doi:10.7759/cureus.10188
15. Tarantino MD, Cuker A, Hardesty B, et al. Recombinant porcine sequence factor VIII (rpFVIII) for acquired haemophilia A: practical clinical experience of its use in seven patients. Haemophilia 2017; 23: 25–32.
16. Baudo F, Collins P, Huth-Kuhne A, et al. Management of bleeding in acquired hemophilia A: results from the European Acquired Haemophilia (EACH2) Registry. Blood 2012; 120: 39–46.
17. Kruse-Jarres R, Kempton CL, Baudo F, et al. Acquired hemophilia A: Updated review of evidence and treatment guidance. Am J Hematol 2017; 92: 695–705.
18. Nagao Y, Yamanaka H, Harada H. A patient with hypereosinophilic syndrome that manifested with acquired hemophilia and elevated IgG4: a case report. J Med Case Rep (2012) 6:63. doi: 10.1186/1752-1947-6-63
19. World Federation of Hemophilia. Carriers and women with hemophilia: The Federation; 2012. https://www1.wfh.org/publication/files/pdf-1471.pdf. Accessed 28 Feb 2020.
20. Gouw SC, van der Bom JG, van den Marijke BH. Treatment-related risk factors of inhibitor development in previously untreated patients with hemophilia a: the CANAL cohort study. Blood. 2007;109(11):4648–54. https:// doi.org/10.1182/blood-2006-11-056291 Epub 2007 Feb 8