ABSTRACT
Acquired hemophilia A (AHA) is a rare disease, defined by the production of anti-factor VIII antibodies causing disordered hemostasis. It is idiopathic in 50% of cases, but sometimes associated with solid tumors. We report a case where AHA led to the diagnosis of lung cancer. CASE REPORT: An 82-year-old man with spontaneous hematomas on his trunk and extremities, and isolated prolongation of activated partial thromboplastin time was admitted to the emergency room. A severely reduced factor VIII level and a high factor VIII inhibitor title confirmed the diagnosis of AHA. Thoracic computed tomography scan found a suspect lung nodule and biopsy was consistent with a primary lung adenocarcinoma. The patient received recombinant factor VIII, immunosuppressive therapies, and finally lung stereotactic radiotherapy. Thirty months after diagnosis, the patient is in complete remission both from AHA and from his lung cancer. CONCLUSIONS: Acquired hemophilia A is a rare but potentially severe disease, which may be idiopathic or linked to a solid tumor. The severity of AHA depends on both the volume of hemorrhage and the presence of associated diseases.
Subject(s)
Adenocarcinoma/diagnosis , Hemophilia A/diagnosis , Lung Neoplasms/diagnosis , Adenocarcinoma/complications , Aged, 80 and over , Diagnosis, Differential , Hematoma/diagnosis , Hematoma/etiology , Hemophilia A/etiology , Humans , Lung Neoplasms/complications , MaleSubject(s)
Antihypertensive Agents/therapeutic use , Histiocytosis, Langerhans-Cell/drug therapy , Hypertension, Pulmonary/drug therapy , Sulfonamides/therapeutic use , Bosentan , Dyspnea/drug therapy , Hemodynamics/drug effects , Humans , Hypertension, Pulmonary/physiopathology , Male , Middle Aged , Piperazines/therapeutic use , Purines/therapeutic use , Severity of Illness Index , Sildenafil Citrate , Sulfones/therapeutic useABSTRACT
Because of their raised prevalence and mortality, association of secondary tumors and inefficiency of therapeutic conventional (surgery, radio- and chemotherapy), head and neck and lung cancers represent true public health problems. The knowledge of the process of carcinogenesis allowed development of approaches of chemoprevention. The vitamin A and its derivatives showed initially a certain efficacy, but an important toxicity and large trials remained negative. For lung cancers, in the event of continuation of the tobacco, beta-carotene and the vitamin A seem even deleterious. Progress in the biology of cancer should allow innovating new approaches of chemoprevention. Today the most effective strategy stays the stop of the tobacco.
