title: Standard anticoagulation for mesenteric vein thrombosis, revealing a 'zebra' diagnosis: hereditary haemorrhagic telangiectasia--the dripping truth!
abstract: A 60-year-old man was treated in the hospital for mesenteric vein thrombosis and discharged home on anticoagulation. On warfarin the patient started to bleed profusely from the nose and tongue. He was evaluated by ENT (ears, nose and throat); a nasal endoscopy revealed several vascular ectasias. Subsequent detailed history and general physical examination established the diagnosis of hereditary haemorrhagic telangiectasia also known as Osler-Weber-Rendu syndrome. On further evaluation, pulmonary arteriovenous malformations were diagnosed on imaging and treated by intervention radiology. In hindsight, the diagnosis could have been made in the general practitioner's office with just a routine thorough history and a physical examination at a new patient visit. We report this case to stress upon the importance of vigilant clinical, medical and family history and a thorough examination to establish an early diagnosis of this not-so-rare entity.
authors.affiliation: Department of Internal Medicine, SUNY Upstate Medical University, Syarcuse, New York, USA.
authors.forename: Aakash
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Arundeep Singh
authors.initials: AS
authors.lastname: Kahlon
authors.forename: Meghan
authors.initials: M
authors.lastname: Rane
authors.forename: Emerald
authors.initials: E
authors.lastname: Banas
mesh_terms: D000792:Angiography / Q000379:methods; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000188:drug therapy*; D008642:Mesenteric Veins; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin