Rupture of the Gallbladder in a Patient with Acquired Factor VIII Inhibitors and Systemic Lupus Erythematosus

Abstract

A 54-year-old woman with a 21-year history of systemic lupus erythematosus (SLE) was admitted to the Matsuyama Red Cross Hospital due to subcutaneous and gingival hemorrhaging. She was diagnosed with acquired factor VIII inhibitors based on a prolonged activated partial-thromboplastin time (APTT) and factor VIII inhibitors. Steroid pulse and factor VIII plasma concentrate were administered to her, not long after which she was transferred to Ehime University Hospital due to gallbladder hematoma. Although her APTT and factor VIII activity were improved after treatment with human factor VIII, she died of multiple organ failure. The autopsy demonstrated a ruptured gallbladder.

Acquired hemophilia in a patient with systemic lupus erythematosus: a case report and literature review

“…The APTT was prolonged but other laboratory screenings for hemostasis such as the platelet count and PT were normal. Similar to cases 6 and 8, the inhibiting autoantibodies could even appear in patients with quiescent SLE [9,10,12], which suggests that the appearance of the FVIII inhibitor and its level does not always correlate with underlying disease activity. We could not find any other possible inductive factor(s) for our SLE patient to develop acquired hemophilia, such as other disease conditions (including skin and respiratory diseases), infections, and use of certain drugs (including penicillin and its derivatives).…”

“…Among previous investigations of acquired hemophilia along with SLE, nine cases (including our case) are available, and the features of these reported cases are summarized in Table 1 [4][5][6][7][8][9][10][11][12]. All cases were female patients of child-bearing age with a median age of 33.9 years (range, 19-54 years).…”

Acquired Inhibitors to Coagulation Factors in a Male Patient with Systemic Lupus Erythematosus: A Case Report and Review of the Literature

“…15,18,22 Among previous investigations of acquired hemophilia along with SLE, ten cases (including our case) are available, and the features of these reported cases are summarized in Table 3. [19][20][21][22][23][24][25][26][27][28] As reported in other similar cases, a careful follow-up of the clotting tests is important to evaluate the response to therapy and the risk of new hemorrhagic manifestations. In our case normalization of the clotting tests were achieved after 6 month since the start of treatment which was enough monotheraphy with prednisolone, although other nine similar cases were needed combination therapy for controlling the disease.…”

Isolierte Gallenblasenverletzung

“…Eine "Perforation" kann einzeitig oder auch zweizeitig entstehen [3,6,7,9,10,12,13,14,15,21,24]. Smith und Hastings [23] haben die Gallenblasenverletzungen in drei Gruppen, 1.…”

“…Heutzutage entstehen solche Verletzungen zumeist im Rahmen von Auto-und Motorradunfäl-len. Es sind allerdings auch Fälle berichtet worden, in denen eine derartige Gallenblasenläsion durch ein Bagatelltrauma [3] oder gar spontan [15] aufgetreten ist.…”