A 68-year-old male, without known allergies, with a history of hypertension, mild chronic renal failure, chronic atrial fibrillation, deficit in type III leading to intestinal thrombosis, venous thrombosis and ileum failure of nine years earlier, was diagnosed.
In March 2005 he came to the emergency department after having presented two melenic stools at home.
Upper endoscopy showed a depapilated portion of the duodenum mucosa without active bleeding.
Lesions located in the colon showed multiple teleangiectatic lesions without active bleeding.
Subsequently, a study with capsule endoscopy revealed multiple ecchymosis in the duodenum, and ileum, cecum and ileum.
After several similar episodes of HDB requiring transfusions, endoscopies and capsule were repeated without new findings.
Scintigraphy with marked signs was also performed, compatible with the existence of angiodysplasia of the small intestine.
During one of the episodes, an angiography was performed, identifying extravasation at the level of arteriovenous fistula and performing embolization with coils, after which he presented an acute abdomen and anastomosis with previous bleeding, and persistence of the anastomosis.
Resection of the ileum was performed, remaining about 80 cm with the ileocecal valve intact.
Despite the intervention, the patient continued with BDH episodes and was treated with somatostatin, with no response.
In the 28 months following the first episode, the patient required a total of 132 seizure concentrates.
Because of the failure of all previous therapies and the non-relevance of new surgical treatments, treatment with thalidomide 100 mg daily was started in early July 2007.
Eight months later, the patient did not develop new episodes of BDH or required any transfusion.
Currently the patient is followed up monthly in external consultations, is asymptomatic except for occasional and mild paresthesias in the lower limbs, with normal electromyography.
The patient had a bilateral episode resolved with anticoagulant therapy.
Given the history of antithrombin III deficiency and the fact that thrombophilia is not described among the possible side effects of thalidomide, we believe that this event is not attributable to the use of thalidomide.
