A rare and life-threatening cause of epistaxis

Epistaxis is a potentially life-threatening condition that can compromise a patient's airway, breathing and circulation. Early recognition of underlying bleeding diatheses that are amenable to medical therapy is imperative in order for timely treatment and to reduce morbidity. We present a case in which acquired haemophilia was diagnosed in an 83-year-old man presenting with seemingly uncomplicated epistaxis. The patient suffered multisite haemorrhages and haemodynamic compromise before definitive management with monoclonal antibody therapy. The case highlights the difficulties in managing this rare condition. It also emphasises the importance of clotting assay analysis in patients who present with epistaxis in the absence of an underlying anticoagulant.