Suspected acquired factor XIII deficiency in a man living with HIV: diagnostic and therapeutic challenges in recurrent spontaneous hemorrhage: a case report.

Factor XIII (FXIII) deficiency is a rare yet potentially life-threatening bleeding disorder, which typically manifests with normal results on routine coagulation assays: a key factor contributing to its frequent underdiagnosis. People living with HIV (PLWH) are predisposed to hemostatic abnormalities; however, the coexistence of HIV infection and a possible acquired FXIII deficiency has been rarely documented in the literature. Herein, we describe a rare case of suspected acquired FXIII deficiency in an HIV-positive man with a well-controlled infection on long-term antiretroviral therapy (ART), who presented with recurrent spontaneous bleeding that led to spontaneous splenic rupture and delayed postoperative hemorrhage. A clot solubility test (CST) demonstrated complete dissolution of the fibrin clot within 24 h, indicating the possibility of FXIII deficiency. Based on clinical manifestations and limited laboratory data, a diagnosis of suspected acquired FXIII deficiency was formulated. In resource-limited settings, a pragmatic management strategy encompasses on-demand cryoprecipitate replacement, and meticulous perioperative planning. Immunosuppressive therapy was administered in consideration of a potential immune-mediated etiology, yet this intervention failed to resolve the patient's recurrent spontaneous bleeding.