title: Severe epistaxis due to aberrant vasculature in a patient with STAT-1 mutation.
abstract: BACKGROUND
  Signal transducer and activator 1 (STAT-1) mutations are rare and have been implicated in combined immunodeficiency, enhanced tumorigenesis, and vascular defects.
  
  
  METHODS
  A 60-year-old woman with a novel STAT-1 mutation and resulting immunodeficiency, squamous cell carcinoma, and vascular disease presented with profuse epistaxis secondary to rupture of an aberrant artery that she developed in part because of this mutation. After unsuccessful posterior packing, embolization was initiated but subsequently aborted because of a bovine origin carotid artery and a history of multiple carotid dissections.
  
  
  RESULTS
  After repeat posterior packing, hemostasis was achieved. No additional episodes of epistaxis occurred in the subsequent 13 months.
  
  
  CONCLUSIONS
  Vascular anomalies can present challenges in epistaxis management. In patients with conditions known to cause vascular anomalies, it is critical to obtain vascular imaging before intervention.
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Chang
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Zachary G
authors.initials: ZG
authors.lastname: Schwam
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hajek
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Boris
authors.initials: B
authors.lastname: Paskhover
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Judson
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000821:virology; D002339:Carotid Arteries / Q000002:abnormalities*; D002340:Carotid Artery Diseases / Q000235:genetics* / Q000628:therapy; D000072226:Computed Tomography Angiography; D004844:Epistaxis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000821:virology; D009154:Mutation; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000821:virology; D050794:STAT1 Transcription Factor / Q000235:genetics*
chemical_list: D050794:STAT1 Transcription Factor; C494079:STAT1 protein, human
keywords: carcinoma; epistaxis; immunologic deficiency syndromes; signal transducer and activator 1 (STAT-1) transcription factor; squamous cell carcinoma of the head and neck; vascular diseases