ABSTRACT
BACKGROUND: Acquired hemophilia A (AHA) is a rare bleeding disease caused by autoantibodies against factor VIII. Spontaneous bleeding symptoms usually affect the skin and muscle, while pericardial effusion is an extremely rare manifestation. In the elderly, anticoagulant treatment is frequent and bleeding symptoms are usually associated with this. CLINICAL FINDINGS: We report a hemorrhagic pericardial effusion as the AHA debut in a patient with untreated chronic lymphocytic leukemia and anticoagulated with apixaban for atrial fibrillation and chronic arterial ischemia. The patient was treated with recombinant activated factor VII to control the active bleeding and corticosteroids and cyclophosphamide to eradicate the inhibitor. In addition, a briefly review of hematological malignancies associated to acquired hemophilia was performed. PARTICULARITIES:: a) anticoagulant treatment may confuse the suspicion of AHA and its diagnosis; b) hemorrhagic pericardial effusion is an extremely rare presentation; c) bypassing agents raise the risk of thromboembolism; d) hematological malignancies rarely cause AHA (<20% of cases). CONCLUSION: A multidisciplinary team is needed to diagnose and manage AHA effectively. The use of anticoagulants may lead to the misdiagnosis of clinical symptoms. Chronic lymphocytic leukemia is one of the main causes of hematological malignancies associated. The specific treatment of CLL is still recommended in the event of active disease.
Subject(s)
Factor VIII , Factor VIIa/administration & dosage , Hemophilia A , Leukemia, Lymphocytic, Chronic, B-Cell , Pericardial Effusion , Pericardiectomy/methods , Aged , Antibodies/blood , Blood Coagulation Tests/methods , Coagulants/administration & dosage , Cyclophosphamide/administration & dosage , Echocardiography/methods , Factor VIII/analysis , Factor VIII/immunology , Hemophilia A/blood , Hemophilia A/complications , Hemophilia A/etiology , Humans , Immunosuppressive Agents/administration & dosage , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Male , Pericardial Effusion/diagnosis , Pericardial Effusion/etiology , Pericardial Effusion/physiopathology , Prednisone/administration & dosage , Radiography, Thoracic/methods , Recombinant Proteins/administration & dosage , Treatment OutcomeABSTRACT
El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal, es un divertículo verdadero, ya que contiene todas las capas de la pared intestinal. Suele ser asintomático o se detecta de manera incidental en las pruebas de imágenes diagnósticas. Tiene un riesgo de complicación de 2-40%, siendo las más frecuentes la hemorragia, la obstrucción intestinal y la diverticulitis. Se describe el caso de un paciente masculino de 52 años de edad, que consultó al servicio de urgencias del Hospital Universitario de Salamanca (España) por un cuadro de dolor abdominal, clínica infecciosa y de obstrucción intestinal. Mediante pruebas de imagen se diagnosticó una obstrucción intestinal secundaria a diverticulitis de Meckel por un enterolito, se realizó intervención quirúrgica y se confirmaron los hallazgos radiológicos descritos.
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a true diverticulum, as it contains all layers of the intestinal wall. It is typically asymptomatic and detected incidentally on diagnostic imaging tests. It presents a 2-40% risk of complications, and the most common ones are hemorrhage, intestinal obstruction and diverticulitis. We presented the case of a 5 2-year-old male patient who was referred to the emergency department of the University Hospital of Salamanca (Spain) with abdominal pain, infectious symptoms besides intestinal obstruction. The imaging tests led to the diagnosis of intestinal obstruction secondary to Meckel's diverticulitis caused by an enterolith. A surgical intervention confirmed the radiological findings described.
