Acquired Hemophilia A Developed Post COVID-19 Vaccine: An Extremely Rare Complication.

Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder caused by circulating autoantibodies (inhibitor) directed against coagulation factor VIII (FVIII). We report a 39-year-old single female who presented to emergency department with sudden onset gross hematuria 10 days following her first dose of Pfizer-BioNTech severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA (coronavirus disease 2019 (COVID-19)) vaccine. Coagulation profile revealed isolated prolongation of the activated partial thromboplastin time due to FVIII deficiency with normal von Willebrand factor and activity. Mixing study revealed time-dependent inhibitor pattern that was successively identified as directed against FVIII using the Nijmegen-modified Bethesda assay. FVIII inhibitor in a titer of 17.2 Bethesda Units/mL was detected. While thrombosis is a frequent complication of severe COVID-19 infection, on the other hand, bleeding is rare in the setting of COVID-19 infection/vaccination with no anticoagulants. Till date, a couple of cases of acquired hemophilia developed after receiving mRNA derived COVID-19 vaccines (Pfizer-BioNTech SARS-CoV-2 mRNA vaccine and Moderna mRNA vaccines) had been reported. It is important to raise the awareness about this rare side effect that might be directly induced by the mRNA COVID-19 vaccine or that the vaccine could have triggered it in a genetically predisposed individual. We recommend considering screening for an inhibitor (by mixing study) in cases with otherwise unexplained onset hemorrhagic disorder and/or isolated activated partial thromboplastin time prolongation.

Diffuse Large B-Cell Breast Lymphoma: A Case Series.

Primary breast lymphoma (PBL) is a rare disease, and few clinicohistopathologic features of the disease have been discussed in previous studies. It represents 2.2% of extranodal lymphomas and constitutes 0.04% to 0.5% of malignant breast neoplasms, despite the clinical and radiographic similarities between breast lymphoma and carcinoma, the prognosis, as reported in the literature, varies. No consensus exists on the best way to treat PBL. However, radiotherapy and chemotherapy were used alone or in combination to treat various cases of PBL. We retrospectively studied 3 cases of PBL of the breast seen in patients attending a tertiary cancer center in Qatar, between 2012 and 2015, in an attempt to determine the common clinical features, therapy, and prognosis of PBL.