Acquired Inhibitor to Factor VIII in a Nonhemophiliac Patient

An 81-year-old man was admitted to another hospital with multiple subcutaneous bruises. Laboratory values obtained there were as follows: hemoglobin 14.7 g/dL; activated partial thromboplastin time, 58 seconds (normal, 25 to 35 seconds); Lee White clotting time, 225 seconds; and platelet count, 588,000/mm3. At the time of transfer to this hospital, a review of the patient’s medical history showed that he had longstanding congestive cardiomyopathy and had taken digoxin and furosemide fot several years. Three months before admission, he was prescribed a quinidine preparation which was discontinued by his physician one week before his admission because of a maculopapular rash. There were scattered large ecchymoses over the neck, extremities, and sublingual area. There was a large hematoma over the left hip at the site of a previous intramuscular injection. The lungs were clear. The cardiovascular examination showed a left ventricular heave, a mitral regurgitant murmur, and an irregular pulse. The stool was hemoccult negative. Joint examination was normal. The laboratory values were as follows: hemoglobin, 10.0 g/dL; white blood count, 20.3/mm3; bleeding time, 5.0 minutes; platelet count, 259,000/mm3; partial thromboplastin time, 44 seconds; prothrombin time, 11.5 seconds (normal, 10.0 to 12.5 seconds); rheu-