Recurrent Intracerebral Hemorrhage in a 30-Year-Old Male With Factor XIII Deficiency: A Case Report

Spontaneous, nontraumatic intracerebral hemorrhage (ICH) in young adults with bleeding diathesis, particularly Factor XIII (FXIII) deficiency, is a rare yet life-threatening condition that affects approximately one-third of patients. FXIII deficiency typically presents at birth with prolonged umbilical bleeding and can manifest later with recurrent episodes of prolonged bleeding, epistaxis, and bleeding from minor injuries. Diagnosing FXIII deficiency is challenging due to a normal coagulation profile, requiring a detailed clinical history and specialized diagnostic tests for FXIII levels. We report a case of a young male with recurrent spontaneous ICH, frequent epistaxis, and prolonged bleeding from minor trauma. The patient was managed conservatively with fresh frozen plasma (FFP) transfusions and supportive care. Prophylactic FFP infusions were initiated every 2 months to prevent further bleeding episodes, accompanied by regular follow-up. The patient made a full recovery and is now leading a healthy life without excessive bleeding, demonstrating the importance of early diagnosis and ongoing treatment. This case highlights the need for clinicians to consider FXIII deficiency in patients with unexplained bleeding, particularly when routine coagulation tests are normal, and underscores the value of timely intervention to prevent severe complications like ICH.