Refractory Epistaxis Caused by an Angiomatous Nasal Polyp Unmasking Moderate Hemophilia A in an Adolescent Male

ObjectivesTo report a diagnostically challenging case of refractory epistaxis in a 16-year-old male that mimicked juvenile nasopharyngeal angiofibroma (JNA), and to highlight critical perioperative lessons regarding coagulation disorders and postoperative wound healing.MethodsDetailed clinical, radiologic, surgical, pathologic, and hematologic data were reviewed.ResultsAn adolescent male presented with recurrent unilateral epistaxis and nasal obstruction. Imaging demonstrated a mildly enhancing posterior nasal mass, and laboratory testing revealed a persistently prolonged activated partial thromboplastin time (APTT). Based on a presumptive diagnosis of JNA, preoperative embolization followed by endoscopic resection was performed. Histopathology revealed an angiomatous nasal polyp. Despite adequate intraoperative hemostasis, the patient developed recurrent postoperative epistaxis refractory to repeated surgical exploration and nasal packing. Comprehensive coagulation studies ultimately demonstrated markedly reduced factor VIII activity, confirming moderate hemophilia A. Sustained hemostasis was achieved only after recombinant factor VIII replacement combined with prolonged, atraumatic nasal compression. No recurrent bleeding occurred during follow-up.ConclusionAngiomatous nasal polyp in adolescent males may closely mimic JNA, particularly when compounded by an unrecognized coagulation disorder. In patients with persistent APTT prolongation, postoperative epistaxis may reflect impaired wound healing rather than inadequate surgical hemostasis. Early hematologic evaluation and appropriate factor replacement are essential to prevent repeated unnecessary surgical interventions.