Acquired hemophilia A developing after pulmonary resection for primary lung cancer

Abstract

A 72-year-old male underwent a right upper lobectomy with mediastinal lymph node dissection for primary lung adenocarcinoma in March 2010. The pathologic stage was pT2aN1M0, stage IIA. Re-thoracotomies were required twice for intrathoracic hemorrhage on the 3^rd and 13^th postoperative days. Further examinations revealed a very low serum level of factor VIII, and a high serum level of factor VIII inhibitor. The disease condition was diagnosed as acquired hemophilia A. Although thoracic empyema and sepsis developed afterward, the patient was treated with an open-window thoracotomy and hemostatic therapy for 3 months, and discharged 243 days after the first operation. When unusual bleeding occurs after surgery for patients with malignant tumors, acquired hemophilia should be listed in the differential diagnoses because it is a rare but fatal disease.