A Rare Case of Crohnʼs Disease Presenting with a Massive GI Bleeding in a Patient with Hemophilia A

Abstract

Coexistence of Inflammatory bowel disease (IBD) and Hemophilia is rare. IBD is a chronic inflammatory condition that is known to be associated with a hypercoagulable state, while hemophilia is due to a deficiency of blood coagulation factors leading to prolonged bleeding. Acute massive gastrointestinal bleeding (GIB) is a rare complication of Crohn's disease (CD). This case reports an unusual initial presentation of Crohn's disease with massive (GIB) in a patient with hemophilia A. A 19 year old caucasian male with history of mild Hemophilia A presented with a 1 week history of painless hematochezia. He denied any abdominal pain, rectal pain, nausea, vomiting, and diarrhea. He denied tobacco, alcohol, and recent NSAID use. On physical examination, patient was tachycardic, hypotensive and had mild diffuse abdominal tenderness, and hematochezia on rectal exam. Laboratory finding was significant for an acute drop in hemoglobin from 10.7 g/dL to 6.7 g/dL within 24 hours of his admission. Given his history of hemophilia, factor VIII level was checked and low at 44 % [normal range of 55%-145%]. Patient was resuscitated with fluids and blood products and given factor VIII replacement. Esophagogastroduodenoscopy was unremarkable. Given his young age and painless hematochezia, meckel's scan was performed and was unremarkable. Subsequently, patient underwent a colonoscopy which surprisingly revealed an inflamed, erythematous, and ulcerated ileocecal valve. The endoscopic findings along with the pathological findings were consistent with CD. Inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein were elevated. Patient was started on prednisone and was scheduled a close hospital follow-up with gastroenterology clinic. IBD is rarely associated with hemophilia. In this subset of patients, IBD may present with an acute painless GIB. IBD is associated with a hypercoagulable state, However it can still occur in patients with an inherited bleeding disorder.