A Case of Severe Recurrent Epistaxis in a Patient with Hereditary Hemorrhagic Telangiectasia who was Treated by Thalidomide and Embolization

Abstract

　　We report a case of severe recurrent epistaxis that was treated by thalidomide and arterial embolization in a patient with hereditary hemorrhagic telangiectasia who required frequent blood transfusions and had undergone nostril closure surgery with limited effect. The patient was a 68-year-old woman with a history of frequent episodes (about 1.5 times a month, on average) of hemorrhagic shock caused by nasal bleeding that necessitated frequent blood transfusions (she had received a total of 60 units of red cell concentrate over the previous 10 months). Daily oral treatment with 50 mg of thalidomide and four sessions of arterial embolization reduced the frequency and duration of the epistaxis. Although thalidomide is effective in reducing the frequency and duration of epistaxis and improving patients' quality of life, it was not very effective in this case. Particular caution is needed in view of the risk of thromboembolism as an adverse effect of this drug. Although arterial embolization has no long-term effects, it should be considered for the treatment of active hemorrhage.