title: Intractable epistaxis and systemic lupus: high-dose intravenous pulse steroids.
abstract: OBJECTIVE
  Epistaxis is most commonly an easily treated ENT entity with a relatively simple algorithm. Occasionally, however, it is encountered as a devastating disease process that can humble the otolaryngologist. In the setting of comorbidities that exacerbate bleeding, in this case vasculitis due to systemic lupus erythematosus (SLE), epistaxis can be life-threatening and refractory to conservative management.
  
  
  METHODS
  This case report describes the hospital course of a patient with severe SLE and intractable epistaxis. We discuss classic management options for epistaxis and offer a novel treatment option for patients with SLE-related vasculitides-goal-directed medical therapy with high-dose intravenous pulse steroid therapy.
  
  
  CONCLUSIONS
  To our knowledge, this report not only is the first description of targeted treatment options for intractable epistaxis in patients with SLE, but also serves to augment the traditional algorithm with the addition of a goal-directed medical therapy-control of epistaxis through high-dose intravenous pulse steroid therapy. We demonstrated that 6 mg of intravenous dexamethasone given every 6 hours can be highly effective in controlling epistaxis in patients with uncontrolled SLE. The presumed mechanism is through control of associated vasculitides.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Waselchuk
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA. Electronic address: dhildrew@tulane.edu.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Hildrew
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Winters
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ellis
mesh_terms: D003907:Dexamethasone / Q000008:administration & dosage*; D004844:Epistaxis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D020551:Pulse Therapy, Drug / Q000379:methods
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone