Background: Systemic lupus erythematous (SLE) presents multiple clinical manifestations associated with laboratory markers. Spontaneous bleeds associated with SLE are uncommon, but they are clinically important.

Aims: Report the diagnosis of SLE in a man with cutaneomucosal bleeding.

Methods: Case report description.

Results: Male, 56 years old, with a history of macroscopic hematuria for about a year and for four months evolving with spontaneous bruises in the upper and lower limbs. There were no reports of abnormal bleeding previously. He was in treatment for bipolar disorder for 36 years. Evaluated by urology, a benign prostatic hyperplasia was identified. In the preoperative period of transurethral resection of the prostate, a change in coagulogram was identified:  activated partial thromboplastin time (aPTT) 58 seconds (control 24 seconds), prothrombin activity 32% (70-100%), international normalized ratio 2.18 (1,00-1,30), with normal platelets and fibrinogen. Mixing test was performed on aPTT with the presence of inhibitor. In laboratory tests carried out, a reduction of coagulation factors (XII, VIII, XI, IX, XI, V) and of ristocetin cofactor 22.36% (40-200%) were found, but the von Willebrand fator activity were normal 79.2% (50-150%). There were positivity for ANA (homogeneous nuclear standard title 1:640), anticardiolipins IgM and IgG, lupus anticoagulant, coombs test, anti-Ro, Anti-dsDNA, Anti-U1RNP. It was found presence of 0.5g /dL monoclonal serum protein, IgM/Kappa, but myelogram did not have plasmacytosis or dysplasias. In his blood count had normocytic and normochromic anemia, without hemolysis, and leukogram with neutropenia and lymphopenia. On computed tomography, he had mild pericardial effusion, signs of pneumonitis and portal hypertension without evidence of thrombosis combined with splenomegaly.

Conclusions: The patient had acquired von Willebrand disease by SLE. Immunosuppressive treatment (prednisone) controled the disease, with improvement of his symptoms and laboratory tests impacting the quality of life.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/systemic-lupus-erythematosus-induced-coagulopathy-a-case-report/