A 13-year-old female patient, with a history of chronic rhinosinusitis, with no family history of hemopathy and asymptomatic up to the age of 8 years, began with frequent epistaxis and low digestive bleeding on at least three occasions.
At the same age and given the antecedents of hemorrhagic diathesis, a hematologic study was carried out in the preoperative evaluation of cystectomy.
An EvW was diagnosed based on aPTT of 48.2 s (VR: 25-39) factor VIII: C of 50% (VR 57-122), vWF: Ag of 37% (VR: 50-146) and co-
Prior to and during cystectomy, a crioprecipitate was indicated, resulting in uneventful recovery of the patient.
In the following years the patient persisted with repeated epistaxis.
At 10 years of age she consulted for painless anterior cervical volume increase.
Hormonal study showed TSH higher than 10 on two occasions (VR: 0.5-5.0) and positive antiperoxidase antibodies, being diagnosed as primary hypothyroidism due to chronic thyroiditis caused by Hamoto.
Treatment was started with levothyroxine 100 ug/day, achieving normalization of plasma thyroid hormone levels at one month of treatment.
Since the initiation of replacement therapy with levothyroxine, the patient has not experienced any episode of epistaxis or gastrointestinal bleeding, even had her menarche at age 12.
Currently its cycles are regular IV/28, without clots, TTPA: 32.3 s, factor VIII: C 80% and FvW: Ag 95%.
