Franchini M, Capra F, Nicolini N, et al. the left elbow, and the right knee, which was warm and swollen. Articular puncture of this knee yielded a Closantel Sodium hematic fluid that did not coagulate. Its cytological analysis showed significant presence of red blood cells, which were also abundantly present in the other cell lines. Activated partial thromboplastin time was lengthened and not corrected by the addition of control plasma. Prothrombin time (Quicks test), fibrinogen level, and vitamin K-dependent factors were without abnormalities. In contrast, factor VIII was collapsed at 7% and the anti-factor VIII antibody was positive. The diagnosis of AH with anti-factor VIII inhibitor was thus retained. With regard to RA, the Disease Activity Score was 6.32 and exhibited a very active RA. Rituximab with methotrexate was begun and the evolution was favorable. After 6 months, the reappearance of the anti-factor VIII inhibitor was found, thus justifying a second cycle of rituximab. Conclusions: AH is not exceptional in RA. Rituximab remains a relevant alternative for managing simultaneous AH with inhibitor and RA. strong class=”kwd-title” MeSH Keywords: Arthritis, Rheumatoid; Biological Therapy; Hemophilia A Background Acquired hemophilia A (AH) is a rare Closantel Sodium hemorrhagic diathesis characterized by the presence of autoantibodies directed against the pro-coagulant activity of factor VIII . Moroccan epidemiological data on acquired hemophilia are not currently available, but its overall annual incidence is about 1C4 per million inhabitants, with an average age of 75 years and without any sex predominance . Its pathogenesis is poorly understood and its prognosis remains severe [3,4]. Indeed, AH always surprises, and kills in 5C15% of cases . It is considered idiopathic in 60% of cases, is associated with autoimmune disease in 20% of cases, and with rheumatoid arthritis (RA) in 4C8% of cases . It may Closantel Sodium be associated with neoplasia, lymphoproliferative syndrome, pregnancy, or multiple transfusions . It usually occurs in older forms of RA, with no association with cause, activity, or severity . The hemorrhagic syndrome is abrupt, sometimes confusing, and can occur without a history of coagulopathy . Acquired hemophilia constitutes a therapeutic emergency that can be rapidly evoked in the presence of any hemorrhagic syndrome Rabbit polyclonal to ACK1 in a context of autoimmunity . Here, we report the case of a patient treated for rheumatoid arthritis who presented with hemorrhagic syndrome in the context of acquired hemophilia with an anti-factor VIII inhibitor. Case Report Our patient was a 66-year-old man who was a 30-pack-year long-time tobacco-smoker who quit smoking 10 years ago, and with a 25-year history of Leo Buerger disease, Closantel Sodium currently in remission. He had been followed up for 20 years for deforming (Figure 1) and severe RA (Figure 2), with positive rheumatic serum (positive for rheumatoid factor and anti-cyclic citrullinated peptide [Anti-CCP]). He had a destructive rheumatoid arthritis, with no systemic impairment, but with an important functional deterioration (difficulty eating, holding a glass, and walking). RA was in low-disease activity at 20 mg daily of leflunomide and 5 mg of prednisone per day. However, the patient presented a polyarticular flare involving the metacarpal-phalangeal (MCP) and the proximal inter-phalangeal (PIP) joints, the left elbow and the right knee were warm and swollen on clinical examination, and with spontaneous ecchymotic patches. There were no other Closantel Sodium extra-articular signs. The general condition was maintained and there were no symptoms of an infection. The articular puncture of this knee yielded a moderate amount of hematic fluid that did not coagulate (Figure 3). Cytological analysis did not show any abnormalities except for a significant presence of red blood cells, which was also found abundantly in the other cell lines. There were no microorganisms or microcrystals. This hemarthrosis suggested a synovial local disease (e.g., villonodular synovitis or synovial angioma). However, in the presence of spontaneous bruising, a general disorder was suspected, especially an acquired abnormality of hemostasis including thrombocytopenia, thrombopathy,.