• Hong Jun Kim, Ye Ji Jung, LeeJun HoJH, Hyun Jung Lee, Chi Hoon Maeng, Sun Kyung Baek, and Jae Joon Han.
• Department of Hematology and Medical Oncology, Kyung Hee University, College of Medicine, Seoul, Republic of Korea.
• Medicine (Baltimore). 2024 Aug 2; 103 (31): e39166e39166.

RationaleAcquired hemophilia A (AHA) is a rare autoimmune disease caused by an antibody that inhibits coagulation factor VIII activity. More than half of patients with AHA cannot identify underlying disorders. The remaining patients are associated with malignancies, autoimmune diseases, skin diseases, infections, and medications. Here, we present a case of 56-year-old Korean man with underlying hypertension, dyslipidemia, and diabetes mellitus who developed AHA following the second dose of BNT162b2 COVID-19 vaccination.Patient ConcernsHe presented with a large 20 × 30 cm-sized hematoma along the psoas muscle and intracranial hemorrhage, necessitating intensive care with mechanical ventilation and continuous renal replacement therapy. Laboratory testing demonstrated that activated partial thromboplastin time and prothrombin times were 74.7 seconds (normal range 29-43 seconds) and 17.2 seconds (normal range 12.5-14.7 seconds), respectively.DiagnosesLaboratory tests confirmed AHA with undetectable factor VIII activity (<1.5%) and a positive factor VIII antibody with a titer of 8.49 Bethesda units/mL.InterventionsRecombinant factor VIIa (NovoSeven®) was administered every 2 hours to control the bleeding, alongside immunosuppression with methylprednisolone 1 mg/kg daily and cyclophosphamide 2 mg/kg daily to eliminate the autoantibody.OutcomesDespite the treatments, the patient developed sepsis and succumbed 14 weeks after admission.LessonsThis rare case underscores the importance of monitoring for AHA following COVID-19 vaccination. Although the benefits outweigh the risks of vaccination, AHA should be considered in the differential diagnosis of unusual bleeding following the vaccinations. Early diagnosis and management before severe bleeding are critical for successfully controlling life-threatening bleeding.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

19 keywords...

hide…