A 54-year-old African-American woman presented with sore throat and bilateral ear pain and was initially treated with oral cephalexin. Ten days into her illness, she presented to an outpatient clinic with swelling of the right neck and an enlarged right submandibular gland. She complained of dysphagia and odynophagia. She was admitted to the inpatient medical ward for observation and was begun on IV antibiotics for treatment of pharyngitis.
Her medical history was remarkable for type 2 diabetes mellitus and hypertension. A recent spontaneous right-calf hematoma had prompted a coagulation workup that showed a prolonged partial prothrombin time (PTT). A diagnosis of acquired hemophilia (antibodies to factor VIII) was made, but no treatment was deemed necessary. Her medications included insulin, benazepril, oxycodone as needed for pain, and cephalexin.