Figure 2.
Ecchymoses due to acquired vWD/acquired hemophilia A. (A) In patient 3, left greater than right upper extremity ecchymoses developed on day 4 after dose 2 of the Moderna SARS-CoV-2 vaccine. (B) A similar right upper extremity ecchymosis had spontaneously developed about 1 year earlier. Although laboratory testing at this time was notable for abnormal ristocetin-induced platelet aggregation and a mildly prolonged aPTT, a definitive diagnosis of acquired vWD/acquired hemophilia A was not made until her hospital presentation, as described in case 3.