Pelvic hemophilic pseudotumor presenting as severe sciatic pain in a patient with no history of hemophilic symptoms

Abstract

Hemophilic pseudotumor is a rare, but well-known complication of hemophilia occurring in approximately 1–2% of patients with severe forms of the disease [1, 2]. A pseudotumor is a collection of encapsulated blood caused by recurrent hemorrhage in bone or soft tissue. Pseudotumors are classified as soft-tissue or osseous based on their location of occurrence [3]. The pseudotumor itself is painless; however, as it grows it causes increasing compression of adjacent structures, leading to necrosis [2]. Nerve compression or compartment syndrome can result in severe pain. Though the diagnosis is straightforward in individuals with known hemophilia, the occurrence of a pseudotumor in a patient without a known history of hemophilia can be a diagnostic challenge [4]. Although the treatment of bleeding episodes in patients with hemophilia is well established, the treatment of hemophilic pseudotumors is difficult, partly because of their rarity. Surgical resection or drainage, chronic factor replacement therapy, external beam irradiation, and other non-surgical measures have been used to treat hemophilic pseudotumors [5, 6]. We herein report a hemophilic pseudotumor in a patient without a history of hemophilia or bleeding tendency who presented with severe right leg pain initially diagnosed as sciatica.