Management of acquired hemophilia a with CyDRi therapeutic strategy: case report

Manejo de hemofilia adquirida con estrategia terapéutica CyDRi: reporte de caso

Introduction: Acquired hemophilia is an autoimmune disease caused by autoantibodies against factor VIII. Its incidence is 1.5 cases per million per year, primarily affecting adults aged 64-78. Until recently, the standard treatment was prednisone, but its high rate of adverse effects and low remission rate led to the search for alternatives. The CyDRi regimen has shown better remission rates, shorter time to achieve remission, and fewer adverse effects. We present the first case in the country treated with this regimen. Case report: A 78-year-old woman with a history of hypereosinophilia syndrome presented with a sudden-onset subcutaneous hematoma in the right upper limb, evolving over three days. Laboratory tests revealed prolonged aPTT, decreased factor VIII levels, and high factor VIII inhibitor activity, confirming acquired hemophilia. CyDRi therapy was initiated, leading to normalization of factor VIII levels and Bethesda units within four days. No bleeding episodes occurred in the first six months, and no major adverse effects were observed. Conclussion: This case highlights the efficacy and safety of the CyDRi regimen as a promising alternative for acquired hemophilia, with the potential to improve clinical outcomes and reduce complications associated with conventional treatments.