A large spontaneous abdominal bruise in a 60-year-old woman: a case report.

OBJECTIVE To report a case of severe abdominal bruising successfully diagnosed using systematic hemostatic investigations. CLINICAL PRESENTATION AND INTERVENTION A 60-year-old woman developed a large spontaneous nontraumatic, painless bruise over the right lower abdominal wall. Computed tomographic scan of the abdomen showed a subcutaneous hematoma beneath the site of the obvious bruise diagnosed as a hematoma. Laboratory tests revealed an activated partial thromboplastin time of 53 s and a factor VIII level of <1%, consistent with the diagnosis of acquired hemophilia A. The patient was treated with steroids and immunosuppressants and her factor VIII levels gradually normalized. CONCLUSION This case report showed that whenever there is spontaneous bruising, factor VIII deficiency should be considered as one of the important differential diagnosis.