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Evaluation ruled out structural causes, revealing prolonged activated partial thromboplastin time (incomplete correction on mixing studies), normal prothrombin time, moderate thrombocytopenia, and lupus anticoagulant and anti-phosphatidylserine\/prothrombin antibody positivity twice, 12 weeks apart. Further evaluation showed very low von Willebrand factor (vWF) levels (&lt;5%). She was treated with pulse methylprednisolone for 3\u2009days, resulting in complete symptom resolution and improvement in vWF levels to 130%. The absence of bleeding history, family history, presence of very low vWF and its response to corticosteroids led to a diagnosis of acquired vWF syndrome as the cause of mucosal bleeding in an SLE patient with concomitant positive antiphospholipid antibody. She was discharged on hydroxychloroquine, mycophenolate mofetil and tapering oral corticosteroids.<\/jats:p>","DOI":"10.1136\/bcr-2024-260824","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T01:01:17Z","timestamp":1725411677000},"page":"e260824","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Converging pathways: acquired von Willebrand disease in systemic lupus erythematosus with antiphospholipid antibodies presenting with persistent menstrual bleeding"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7527-2936","authenticated-orcid":false,"given":"Ankush","family":"Garg","sequence":"first","affiliation":[{"name":"Department of Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2844-3287","authenticated-orcid":false,"given":"Gaurav","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjan","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritesh Kumar","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"2025082703294976000_17.9.e260824.1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1055\/s-0037-1614018","article-title":"Acquired von Willebrand syndrome: data from an international registry","volume":"84","author":"Federici","year":"2000","journal-title":"Thromb Haemost"},{"key":"2025082703294976000_17.9.e260824.2","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.transci.2017.04.006","article-title":"A case of autoimmune severe acquired von Willebrand syndrome (type 3-like)","volume":"56","author":"Gavva","year":"2017","journal-title":"Transfus Apher Sci"},{"key":"2025082703294976000_17.9.e260824.3","doi-asserted-by":"crossref","DOI":"10.1055\/s-0038-1649623","article-title":"International survey of patients with von Willebrand disease and angiodysplasia","volume":"70","author":"Fressinaud","year":"1993","journal-title":"Thromb Haemost"},{"key":"2025082703294976000_17.9.e260824.4","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/RHU.0000000000001284","article-title":"Characteristics of Acquired Inhibitors to Factor VIII and Von Willebrand Factor Secondary to Systemic Lupus Erythematosus: Experiences From a Chinese Tertiary Medical Center","volume":"27","author":"Cao","year":"2021","journal-title":"J Clin Rheumatol"},{"key":"2025082703294976000_17.9.e260824.5","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1182\/blood.V31.6.806.806","article-title":"Acquired von Willebrand\u2019s syndrome in systemic lupus erythematosus","volume":"31","author":"Simone","year":"1968","journal-title":"Blood"},{"key":"2025082703294976000_17.9.e260824.6","doi-asserted-by":"crossref","first-page":"1013764","DOI":"10.3389\/fped.2022.1013764","article-title":"Case report: A case of acquired von Willebrand syndrome as onset clinical presentation of systemic lupus erythematosus manifested as epistaxis and pulmonary hemorrhage","volume":"10","author":"Wang","year":"2022","journal-title":"Front Pediatr"},{"key":"2025082703294976000_17.9.e260824.7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.clinbiochem.2022.12.007","article-title":"Anti-phosphatidylserine\/prothrombin complex antibodies (aPS\/PT) increase the risk for thrombosis based on lupus anticoagulant positivity","volume":"112","author":"Zhang","year":"2023","journal-title":"Clin Biochem"},{"key":"2025082703294976000_17.9.e260824.8","doi-asserted-by":"crossref","unstructured":"Kubisz P , Holly P , Stasko J . 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