Vascular ectasia of the whole intestine as a cause of recurrent gastrointestinal bleeding after high-dose chemotherapy.
We present the first case in the literature of vascular ectasia of the whole intestine as a cause of recurrent and profuse gastrointestinal bleeding in a patient with relapsing Hodgkin's disease. The 17-year-old patient experienced early relapse of his Hodgkin's disease after first-line chemotherapy. Salvage chemotherapy was followed by high-dose chemotherapy and autologous stem cell transplantation. Complete remission was achieved after another relapse by means of a second transplant. The patient presented with profuse gastrointestinal bleeding 5 months later, however. Gastric antral vascular ectasia following hematopoietic stem cell transplantation was diagnosed by endoscopy, with histological confirmation. Similar lesions were found in the duodenum, the ileum, and throughout the entire colon. In conclusion, vascular ectasia of the whole intestine should be considered as cause of acute gastrointestinal bleeding after stem cell transplantation. Physicians should be aware of this complication because its onset is typically delayed. Importantly, this disease is not limited to patients who have undergone allogeneic transplantation, but can also occur after autologous transplantation.
Schmidmaier
R
R
Department of Hematology and Oncology, Innenstadt Medical Clinic, Clinic of the University of Munich, Munich, Germany. ralf.schmidmaier@med.uni-muenchen.de
Bittmann
I
I
Götzberger
M
M
Straka
C
C
Meinhardt
G
G
Eigler
A
A
D000293:Adolescent; D016888:Angiodysplasia / Q000150:complications*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003106:Colon / Q000098:blood supply; D003113:Colonoscopy; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000098:blood supply; D007410:Intestinal Diseases / Q000150:complications*; D008297:Male; D012008:Recurrence