Esophageal ulcer associated with mild hemophilia A: case report

Abstract

In this paper, we present the case of a 68-year-old male with personal medical history of coagulopathy issues, who presented to our Emergency Room (Emergency County Hospital, Arad, Romania) with bleeding of the superior tract of the digestive system; the case was difficult to manage, thus warranting the intervention of the Department of Gastroenterology. Endoscopy was performed to localize the site of bleeding and to stop the hemorrhage. This procedure was not successful. The patient was transferred to our Intensive Care Unit where different medications, such as proton pump inhibitor, hemostatic agent and prokinetic drugs were administered. Unfortunately, our attempt to stop bleeding failed; this led us to expand our investigation. We focused on a possible hemophilia as the cause of bleeding, which was confirmed as hemophilia A through the coagulometry test after a period of three days. Patient medical history and coagulation test led us to believe that this is a very rare case of a mild hemophilia A. Finally, the correction of Factor VIII deficiency and repeated endoscopic hemostasis clip was able to stop patients bleeding and ensured a favorable clinical evolution of the patient.

Figure 1

The endoscopic images of the patient at the time of hospital admission: (A) Esophageal hemorrhagic ulcer; (B) Endoscopic hemostasis using clips.

Figure 2

The radiographic images of the patient: (A) The radiographic image on admission time shows bilateral alveolar condensation and hilar stasis; (B) The radiographic image after two days of intensive treatment shows only hilar stasis.

Figure 3

CT images after few days of intensive treatment: (A) CT angiography image of proximal portion of esophagus; the normal structure of esophageal and tracheal wall; lack of contrast-media extravasation from vascular structure; (B) CT angiography image of distal portion of esophagus; the image also shows normal structure of esophageal and tracheal wall; lack of contrast-media extravasation from vascular structure. CT: Computed tomography.

Figure 4

(A) Peripheral blood smear showing microcytic, hypochromic red blood cells; (B) Microcytic, hypochromic red blood cells and normal platelets. May-Grünwald–Giemsa (MGG) staining: (A) ×400; (B) ×1000.