Acquired factor VIII deficiency presenting as a floor of the mouth swelling

Abstract

The authors report the case of a patient with previously undiagnosed acquired haemophilia A who presented to the accident and emergency department with a swollen tongue and difficulty in swallowing. There were no signs of trauma or obvious dental infection. She was admitted onto a high dependency unit for observation. Over the course of the day, the floor of her mouth and neck became increasingly swollen to the extent that she developed breathing difficulties. She was transferred to an intensive care unit, where she was intubated to protect her airway from further compromise. Acquired factor VIII deficiency was diagnosed and appropriate treatment commenced. Despite intervention, her respiratory and cardiovascular functions deteriorated. Following discussions between the medical specialities involved in her care and her family, the decision was made to withdraw support. The patient passed away 96 h after admission.

Figure 1

(A,B) CT images show sublingual swelling with no evidence of a discrete mass or collection.