Transient Acquired Hemophilia Associated with Mycoplasma Pneumoniae Pneumonia

Abstract

Acquired hemophilia is a rare disorder caused by autoantibodies to factor VIII (FVIII) (also referred to as factor VIII inhibitors or anti-FVIII) and may be associated with pregnancy, underlying malignancy, or autoimmune disorders. A 33-month-old girl who presented with hematochezia and ecchymotic skin lesions was diagnosed with Mycoplasma pneumoniae pneumonia by serology and polymerase chain reaction. Hematologic studies showed a prolonged activated partial thromboplastin time (aPTT), partially corrected mixing test for aPTT, reduced levels of FVIII, and the presence of antibodies against FVIII. She was treated conservatively with prednisone and intravenous immunoglobulin (IVIG) without FVIII transfusion and recovered without sequelae. This report provides the first description of acquired hemophilia due to anti-FVIII in association with M. pneumoniae in Korea. We discuss this case in the context of the current literature on acquired hemophilia in children.

Evaluation on blood coagulation and C-reactive protein level among children with mycoplasma pneumoniae pneumonia by different chest imaging findings

“…In several reports, MP infection transiently influenced the activity of many coagulation factors, including II, VIII, or X. [ 38 ] One possible mechanism behind this phenomenon is the consumptive coagulopathy due to hepatic deterioration. As a main inhibitor of thrombin, antithrombin III plays a protective role in the coagulation system.…”

The First Case of Postpartum Acquired Hemophilia A in Korea

“…There have been a couple of published reports on AHA in Korea, in associated with Mycoplasma pneumoniae infection and Cobra toxin intake ( 19 , 20 ). However, this is the first report on postpartum AHA in Korea.…”

Acquired Hemophilia A

“…자가면역성 질환(전신홍반루푸스, 류마티스관절염 등), 악성종양, 임신 (대부분 첫 번째 임신에서 발생하며, 출산 후 1-4개월에 발생함. 자가항체 가 태반을 통과하므로 태아에 출혈 위험이 있음), 5,6 감염, 7 약제 등 후천성 혈우병 A 발생에 관련된 원인이 있는 경우가 50% 정도 되며, 나머지 50% 에서는 원인불명(idiopathic)으로 밝혀진 관련된 질환 없이 발생하는 것으 로 알려져 있다. 1,8 비록 약 30% 정도에서는 출혈이 심하지 않아 출혈에 대 한 지혈치료가 필요 없으나, 최근의 대규모 보고에 따르면 94.6%에서는 출 혈성 임상양상이 동반되었고, 77%의 자연출혈과 70%의 심각한 출혈(혈 색소 < 8 g/dL 또는 혈색소 >2 g/dL 감소로 정의됨)이 관찰되었다.…”