CC: 2 days of L knee pain and swelling
ID: 58 yo homeless male with alcohol abuse and seizure disorder presents with 2 days of L knee pain and swelling. He reports a history of frequent falls (while intoxicated) and increased joint swelling after these falls over the past 4-5 months. Exam was notable for diffuse L knee swelling, full ROM, stable varus/valgus maneuvers, negative posterior drawer test with improvement in pain with passive motion. Joint fluid analysis demonstrated markedly bloody red fluid with 1,333 nucleated cells, 25% neutrophils, 40% lymphocytes, 29% monocytes, and 6% eosinophils. Labs were notable for Hgb of 8.8, Plts of 384, and PTT of 84 secs which did not correct on mixing study – subsequent workup with a Factor VIII inhibitor assay was remarkable at 760 Bethesda Units. Patient was ultimately found to have a renal cell carcinoma (RCC) and diagnosed with hemarthrosis likely secondary to acquired Factor VIII inhibitor from his underlying RCC.
Pearls from morning report:
- Causes of bloody joint effusions include: hemophilia, trauma, malignancy, Charcot joint, and arteriovenous malformations.
- Causes of acquired factor inhibitors include: pregnancy, malignancy, drugs,
The lupus anticoagulant antibody was identified by our very own Dr. Donald Feinstein in 1972. Dr. Feinstein continues to round with our hematology consult service here at LAC+USC!
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