A case of acquired hemophilia A and bullous pemphigoid following SARS-CoV-2 mRNA vaccination

Pei An Fu, Chien Wei Chen, Ya Ting Hsu, Kai Che Wei, Peng Chan Lin, Tsai Yun Chen

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7 Citations (Scopus)


Acquired hemophilia is a rare disease resulting from autoantibodies against endogenous factor VIII (FVIII), which associates with bleeding and a high mortality rate. The pathophysiology is still unclear. Recent studies suggest genetic and environmental factors trigger the breakdown of immune tolerance. We report a 77-year-old Taiwanese man presented with multiple ecchymoses and some hemorrhagic blisters three weeks after SARS-CoV-2 mRNA (Moderna) vaccination. Isolated activated partial thromboplastin time (aPTT) prolongation was found. Acquired hemophilia A (AHA) was confirmed by low factor VIII (FVIII) activity and high titer of FVIII inhibitor. The pathohistology of skin biopsy further supported the concomitant diagnosis of bullous pemphigoid. To date, 6 cases of acquired hemophilia A following SARS-CoV-2 mRNA vaccination were reported worldwide. We reviewed and summarized the characteristics of these cases. We also discussed the rare finding of concomitant acquired hemophilia A and bullous pemphigoid. Bullous pemphigoid results from autoantibody against epithelial basement membrane zone of skin. In this article, we proposed possibility of SARS-CoV-2 mRNA vaccine associated autoimmunity against FVIII and epithelial basement membrane zone.

Original languageEnglish
Pages (from-to)1872-1876
Number of pages5
JournalJournal of the Formosan Medical Association
Issue number9
Publication statusPublished - 2022 Sept

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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