Aortoduodenal fistula in a patient on intravitreal bevacizumab injections: a case report.
An 88-year-old woman on long-term intravitreal bevacizumab presented with acute gastrointestinal hemorrhage. She was stabilized and underwent nonrevealing upper endoscopy. She continued to require intermittent blood transfusions, and resulting computed tomography of the abdomen revealed an aortoduodenal fistula. The patient was undergoing treatment for her macular degeneration with intravitreal bevacizumab, an angiogenesis inhibitor frequently used to treat solid organ malignancies. Systemic administration has been associated with serious adverse events, including gastrointestinal hemorrhage, perforation, and fistula formation. Intravitreal bevacizumab has been used off-label to treat macular degeneration, but data on the safety of this therapy are limited. Given her lack of other risk factors, the authors postulate a potential association between intravitreal bevacizumab and aortoduodenal fistula formation in this patient.
Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL.
Amber N
AN
Pepper
Mauricio O
MO
Valenzuela
Kellee L
KL
Oller
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D001018:Aortic Diseases / Q000139:chemically induced*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000139:chemically induced*; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy; D016157:Vascular Fistula / Q000139:chemically induced*
D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab