-A 16 years-old male, smoker, manual worker

Chronologically:

-About three months ago, on the eve of Eid Al Adha feast and after hard manual work and lifting, he awakened with high-grade fever with no other reported symptoms, for which he was given N.S.A.I.D. (diclofenac) injection, temperature subsided

-On the 2^nd day he suffered from: attacks of melena, left thigh pain and swelling preventing him from moving

-Lower limb duplex study: no abnormality detected

-Upper G.I. endoscopy: mild duodenitis

-When referred to us he had:

-Toxic facies

-Anemic manifestations

-swollen, hot, tender left thigh

-Rapidly we consider this scenario: hard work, thigh swelling, intramuscular progressive haematoma, with superadded infection, N.S.A.I.D. injection may exacerbate the condition with resultant melena, all of which is a result a "Haemophilia" syndrome, most probably Type B (Christmas Haemophilia)

-Accordingly, and because of the critically of the patient, we rapidly initiated antibiotic with plasma infusions, which resulted in a dramatic response

-N.B. MRI reports of the thigh gave different various differential diagnoses, but oddly organized haematoma was not among them, on the contrary to what we have relied on, and on the contrary to the marvelous patient's response, so be cautious when dealing with reports because time is very critical not to be wasted on remote differential diagnoses especially in critically-ill patients!   

 

Consider This case with the one in: Situiation 29