ro13-9904 and Epistaxis

A 69-year-old man developed

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Ceftriaxone; Epistaxis; Gram-Positive Bacterial Infections; Humans; Male; Nail Diseases; Nails; Platelet Count; Postoperative Complications; Propionibacterium acnes; Thrombocytopenia; Treatment Outcome; Vancomycin

Factor XIII (FXIII) is a fibrin-stabilizing factor consisting of catalytic A subunits (FXIII-A) and carrier B subunits (FXIII-B). Congenital FXIII deficiency is a rare bleeding disorder. Acquired FXIII deficiency resulting from FXIII hypo-synthesis and/or hyperconsumption is a relatively common disorder in which patients seldom bleed. On the contrary, 'autoimmune/acquired hemorrhaphilia XIII/13 due to anti-FXIII antibodies (AH13)' is a rare but life-threatening bleeding disorder. Through a nationwide survey of AH13, we diagnosed aggressive AH13 in a 66-year-old woman. She consulted our department because of a spontaneous hematoma in her hand. After 1.5 months, she also developed an intramuscular hematoma but retained approximately half (52%) of the normal FXIII activities. The patient's bleeding symptoms were aggravated to catastrophic massive bleedings in the large abdominal muscles and intrapelvic and intraperitoneal spaces. Two months after the bleeding onset, she died despite undergoing plasma exchange, which was performed because we were deeply suspicious of the presence of an anti-FXIII inhibitor. Seven days after her death, extremely low FXIII activity (6%) and positive data on anti-FXIII inhibitor were reported by a commercial laboratory. Our dot blot assay detected anti-FXIII-A autoantibodies, afterwards. Thus, the diagnosis of aggressive AH13 as early as possible is necessary to save patients' lives.

Topics: Aged; Anti-Bacterial Agents; Autoantibodies; Autoimmune Diseases; Ceftriaxone; Delayed Diagnosis; Disease Progression; Epistaxis; Factor XIII; Factor XIII Deficiency; Fatal Outcome; Female; Gingival Hemorrhage; Hematoma; Hemodiafiltration; Hemoperitoneum; Hemorrhagic Disorders; Humans; Neurosyphilis; Partial Thromboplastin Time; Plasma Exchange

An 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya.

Topics: Acetaminophen; Adolescent; Analgesics, Non-Narcotic; Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Epistaxis; Female; Folic Acid; Humans; Pseudoxanthoma Elasticum; Vitamin B Complex