Recurrent hemoptysis after laryngectomy-acquired hemophilia induced by laryngeal cancer surgery and chemoradiotherapy: A case report

BACKGROUND: Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder characterized by autoantibodies against coagulation factor VIII (FVIII), leading to spontaneous bleeding in patients without a personal or family history of bleeding disorders. While AHA has been reported in association with various cancers, this case represents, to our knowledge, the first reported instance of AHA following head and neck cancer surgery and subsequent chemoradiotherapy. CASE SUMMARY: edition) who developed AHA after extensive surgical resection and chemoradiotherapy. He presented with recurrent hemoptysis and ecchymosis. Coagulation studies showed isolated prolonged activated partial thromboplastin time of 83.8 seconds that did not correct with mixing studies. FVIII activity was < 1%, and a Bethesda assay confirmed FVIII inhibitors with a titer of 18.4 Bethesda units. Hemostasis was initially achieved with tranexamic acid and batroxobin. Immunosuppression with prednisone and cyclophosphamide was started; due to gastrointestinal bleeding, rituximab was added. Treatment was later transitioned to azathioprine with prednisone, followed by tapering. FVIII activity recovered to 188.2%, and the patient remained in remission over six years without AHA or malignancy recurrence. CONCLUSION: This case underscores vigilance for AHA after head and neck cancer therapy to enable prompt treatment.