73-year-old woman with arterial hypertension, osteoarthritis of both hips, chronic lymphoid leukaemia, operated meningioma of the left cerebellopontine angle, segmental resection of the sigmoid colon due to diverticulitis and peritonitis, paroxysmal atrial fibrillation, aortic stenosis and hypertensive heart disease treated with Manidon retard®, Ameride® and Sintrom®. He presented with numerous recurrent episodes of gastrointestinal bleeding in the form of melena and rectorrhagia since April 2006. There were no significant abnormalities in platelet numbers or function. Sintrom was withdrawn in September 2006. The haemorrhages involved: 9 hospital admissions, 4 colonoscopies, 4 gastroscopies, 2 capsule endoscopic examinations and 1 double-balloon enteroscopy with oral and anal access. These endoscopic examinations led to the diagnosis of xanthomas and petechial red spots in the jejunum and ileum treated with argon, small hyperplastic gastric polyp removed and small angiodysplasias in the ascending colon also treated with argon. The patient received subcutaneous octreotide at a dose of 0.1 mg every 12 hours which was not well tolerated and was discontinued. Hormonal treatment was discarded because of the increased risk of inducing vascular thrombosis given the patient's lymphoproliferative disease. Despite endoscopic and medical treatment, the gastrointestinal bleeding persisted and 24 red blood cell concentrates were required until March 2008. The use of thalidomide at a dose of 300 mg per day in two doses was then considered. After assessment of the patient by haematologists and neurologists and an electromyogram and explanation to the patient of the precautionary measures to be taken (regarding the exclusive personal use of thalidomide), an application was made to the Ministry of Health for its compassionate use. In the first 2 months of treatment the patient had occasional rectorrhagia and it was necessary to transfuse 3 more red blood cell concentrates. In the following 4 months, no further transfusions or admissions due to new episodes of gastrointestinal bleeding have been necessary. Thalidomide has been well tolerated. Since receiving treatment, the patient has presented blurred vision due to cataracts and oedema in the lower limbs related to her heart disease, both unrelated to the thalidomide.

