Acquired factor VIII inhibitor is a rare occurrence and may cause severe bleeding by interfering with the coagulation cascade. We report an interesting case of a 59-year-old white man with an acquired factor VIII inhibitor and lupus anticoagulant. Clinical findings included large hemorrhagic areas of the extremities, a prolonged activated partial thrombin time (aPTT) that did not correct with mixing studies and an elevated Bethesda assay. Treatment consisted of high-dose steroids with a tapering dosage. An acquired factor inhibitor should be considered in patients presenting with a prolonged aPTT that does not correct with mixing studies.