Hemophilic Pseudotumor of the Distal Parts of the Radius and Ulna: A Case Report

Abstract

B leeding into joints and muscles is a known complication of hemophilia1,2. Circulating levels of factor VIII are closely related to the severity and frequency of the bleeding3. When the factor-VIII level is <1%, bleeding can be severe and serious hemarthrosis occurs. When the level is between 1% and 5%, gross bleeding may occur after minor trauma. When it is between 5% and 25%, severe bleeding usually occurs only with trauma or surgery, and when it is between 25% and 50%, bleeding occurs only after severe trauma3. Hemophilia is classified as severe when the factor-VIII level is <1%, moderate when it is between 1% and 5%, and mild when it is between 5% and 25%4. Pseudotumors and cysts may arise from hemorrhage into muscles or within the subperiosteal space and can lead to destruction of adjacent muscles, nerves, vessels, and bone5,6. The frequency and severity of hemophilic pseudotumor have both decreased substantially with the use of factor-VIII replacement therapy6-8. However, this serious complication may still occur in remote areas of developing countries, where the diagnosis may be delayed and factor-VIII replacement therapy is not readily available. We report a case of pseudotumor occurring in a young man from a remote area of Sudan, where medical treatment for hemophilia is not readily available. The pseudotumor, affecting the distal parts of the radius and ulna, was successfully treated with factor-VIII replacement therapy and surgical intervention. The patient was informed that data concerning the case would be submitted for publication. Fig. 1 Photograph made at presentation, demonstrating the ruptured cyst and contractures of the fingers. A sixteen-year-old boy with hemophilia presented to the Khartoum Teaching Hospital with an open wound on the volar surface of the distal …