A Case of Acquired Hemophilia A Following SARS-CoV-2 Infection

Acquired hemophilia A (AHA) is a rare bleeding disorder caused by antibodies against coagulation factor VIII. The majority of AHA cases are reported in an elderly population with chronic co-morbidities but can also be associated with other conditions, drugs, infections, and pregnancy. AHA is likely under-diagnosed and often unrecognized due to limited data about incidence, diagnosis, and management. We report a patient with no significant medical history who developed spontaneous ecchymoses and hematomas after a recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection complicated by a pulmonary embolism. These skin manifestations were initially thought to be related to the use of the direct oral anticoagulant apixaban, but further investigation revealed the presence of factor VIII inhibitors confirming the diagnosis of AHA. The patient was treated with prednisone and cyclophosphamide to eradicate the inhibitors with excellent response. Literature review shows a few cases of AHA after coronavirus disease 2019 (COVID-19) vaccination, H1N1 vaccination, and two cases after COVID-19 infection.