Acquired von Willebrand disease in a patient with monoclonal gammopathy of undetermined significance

We describe a patient with acquired von Willebrand disease (vWD), who had typical presentation and clinical manifestations of acquired vWD, but correct diagnosis was delayed because of lack of awareness and early recognition. The patient was initially seen at a community hospital with persistent nasal mucosal bleeding and was transfused with an excessive amount of cryoprecipitates before appropriate hemostatic evaluation. Hemostasis work-up revealed that he had classic features of acquired vWD. Further extensive evaluation revealed the patient to have monoclonal gammopathy of undetermined significance (MGUS). He was refractory to a high dose of corticosteroids and had a very transient response to desmopressin acetate (less than 4 hours) but responded well to a high dose of intravenous immunoglobulin (IVIG), which lasted at least 3 weeks with each treatment. He remained very responsive to IVIG 2 years later. His underlying MGUS has not progressed during the past 4 years.