Spontaneous iliopsoas muscle hematoma in a patient with von Willebrand disease: a case report

A 20-year-old Iranian man was referred to our emergency ward because of the gradual onset of right flank pain. He was known to have been diagnosed with von Willebrand disease type 3 at age two years old. Magnetic resonance imaging showed a mass in the right iliopsoas muscle. The diagnosis of iliopsoas hemorrhage and partial femoral nerve palsy was established, and he responded to medical treatment.We report a case of von Willebrand disease type 3 with spontaneous iliopsoas hematoma associated with femoral nerve palsy that was well managed with Humate-P treatment.Von Willebrand disease (vWD) is a hereditary bleeding disorder caused by a quantitative or qualitative defect of von Willebrand factor. The prevalence of this disease is estimated to be 1% to 2% of the general population. Von Willebrand factor is a coagulation factor for initial stages of blood clotting and is also a carrier for factor VIII. Patients with vWD develop coagulation platelet plugs and red coagulation clots are unable to form. vWD consists of a broad variation of clinical manifestations, with one extreme being a minimal bleeding tendency and the other being a severe presentation such as severe hemophilia A. Luckily, most of these patients present with mild to moderate clinical symptoms. The severe type of the vWD, type 3, occurs in less than 5% of patients. The inheritance pattern of this type is usually autosomal recessive. Patients with vWD usually show clinical features such as recurrent nosebleeds, easy bruising, bleeding post-tooth extraction, post-tonsillectomy or other surgical bleeding, and excessive menstrual bleeding.Musculoskeletal hemorrhage occurs commonly in vWD type 3-like hemophilia A. Iliopsoas hemorrhage is a potentially serious complication because a delay in beginning treatment may result in permanent femoral nerve palsy [1]. The present case report describes a man with vWD type 3 who had a spontaneous iliopsoas hematoma that responded well to Humate-P treatment (CSL Behring,