First Case of Acquired Hemophilia B in a Patient with HIV Infection: Case Report and Literature Review

Abstract

Acquired hemophilia B is a rare bleeding disorder in which circulating specific antibodies inhibit the coagulation factors. Usually, it is associated with autoimmune diseases, malignancy and some infections such as hepatitis B (HBV) and C (HCV) viruses. The association with the human immunodeficiency virus (HIV) is rare. We present the first case of hemophilia B acquired in a patient with HIV. A 36-year-old woman with a history of HIV infection stage 3 acquired immunodeficiency syndrome (AIDS) (CDC 2014) and glomerulopathy secondary to HIV. She consulted for subacute non-dysenteric diarrhea. During her hospitalization, bacteremia by methicillin-sensitive Staphylococcus aureus ( S.au reus) was documented, requiring hemodialysis catheter replacement with profuse bleeding during the procedure. The coagulation tests showed prolonged activated partial thromboplastin time (aPTT), normal prothrombin time (PT), mixing test with Rosner index: 8.8%, negative lupus anticoagulant, and specific tests for normal factor VIII and XI. The activity of factor IX was <50% and the inhibitor was increased, which confirms the diagnosis of hemophilia B. Acquired hemophilia B in a patient with HIV infection is not a frequent association; it should be suspected in the context of bleeding with prolonged aPTT.

Coexistence of Acquired Hemophilia and Antiphospholipid Serology in Monoclonal Gammopathy Patient

“…Of the reported cases, seven received steroids alone or were associated with other immunosuppressants, such as rituximab, vincristine or cyclophosphamide. 12 Our patient received oral cyclophosphamide and antibodies control showed a success of eradication at the end of treatment.…”

Characteristics of Acquired Inhibitors to Factor VIII and Von Willebrand Factor Secondary to Systemic Lupus Erythematosus

“…The activated partial thromboplastin time (aPTT) is prolonged in most cases 1 . The AH includes acquired von Willebrand syndrome (AVWS), acquired hemophilia A (AHA), and other diseases 2,3 . The subclinical presence of AH is extremely rare.…”

“…1 The AH includes acquired von Willebrand syndrome (AVWS), acquired hemophilia A (AHA), and other diseases. 2,3 The subclinical presence of AH is extremely rare. The European Acquired Hemophilia Registry has reported that 6.6% (33/501) AHA patients did not present with bleeding.…”