Life threatening and occult mediastinal haemorrhage secondary to acquired factor VIII deficiency.

Dear Editor, Acquired Factor VIII (FVIII) deficiency is a rare disorder occurring at a rate of approximately 1 person per million each year.1 It is due to the spontaneous development of auto-antibodies against FVIII. In 50% of the cases, no cause is identified, although it can be associated with pregnancy, autoimmune disease and malignancy.1 Inhibition of FVIII occurs and patients may present with spontaneous ecchymoses, mucosal bleeding and muscular haematomas. Bleeding can sometimes be massive and potentially lifethreatening, hence, acquired FVIII deficiency is an important differential diagnosis to consider in patients presenting with coagulopathy. We present a rare case of acquired haemophilia presenting with spontaneous and clinically occult mediastinal haemorrhage.