Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder that leads to mucocutaneous
telangiectasias,
epistaxis, and gastrointestinal
bleeding. Depending on the severity and manifestation of the disease, various therapeutic modalities have been used, from local
bleeding control to surgery or concomitant
drug therapy. Several articles under review have presented guidelines for treatment of HHT with
bevacizumab as a direct anti-angiogenesis strategy. Still, neither the exact optimal dose nor the minimum effective dose of intravenous
bevacizumab in patients with severe HHT has been reported. A 55-year-old man presented with long-standing
epistaxis, recent
melena,
dizziness, and a three-generation family history of chronic
epistaxis,
anemia, and regular
blood transfusions. Treatment with
argon plasma coagulation (APC) for the gastrointestinal
bleeding failed to raise
hemoglobin levels, we considered using the
bevacizumab. We report a patient with severe HHT, who was treated with low-dose
bevacizumab (2 mg/kg) and improved substantially.