Dupilumab-Associated Acquired Hemophilia A in an Elderly Male With Severe Eczema

This is a case of an 80-year-old Caucasian male with no personal or family history of coagulopathy, who was admitted for new onset painless hematuria followed by skin and significant deep soft tissue hemorrhage, with resultant anemia requiring blood transfusions. The hematuria started 1 week after he received an initial dose of subcutaneous injection of dupilumab for the treatment of refractory eczema. Few days later, he had spontaneous bruising on the tongue, anterior neck, right arm and entire left lower extremity in the absence of trauma and strenuous physical activity. His hemoglobin dropped to 7.2 g/dL from a baseline of 15.0 g/dL. Laboratory tests revealed a prolonged partial thromboplastin time, reduced factor VIII activity, and presence of factor VIII inhibitors. Three units of packed red blood cells were transfused and oral prednisone 1 mg/kg daily was initiated. His hemoglobin stabilized. No further bleeding was noted and the ecchymoses gradually resolved. J Med Cases. 2019;10(7):206-208 doi: https://doi.org/10.14740/jmc3336