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  • Rituximab to the rescue: novel therapy for chronic gastrointestinal bleeding due to angiodysplasia and acquired von Willebrand syndrome

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Small bowel and Nutrition
Case report
Rituximab to the rescue: novel therapy for chronic gastrointestinal bleeding due to angiodysplasia and acquired von Willebrand syndrome
  1. James Hawken1,2,
  2. Amy Knott3,
  3. Wesam Alsakkaf4,
  4. Amanda Clark3,
  5. Faisal Fayyaz1
  1. 1 Department of Gastroenterology, Weston General Hospital, Weston-super-Mare, UK
  2. 2 Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 Bristol Haematology Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  4. 4 Department of Haematology, Weston General Hospital, Weston-super-Mare, UK
  1. Correspondence to Dr James Hawken, Department of Hepatology University Hospitals Bristol NHS Foundation Trust Bristol UK ; jameshawken{at}doctors.org.uk

Abstract

Identification of acquired von Willebrand syndrome (AVWS) was key to treating a patient with chronic gastrointestinal (GI) bleeding due to angiodysplasia. After exhausting endoscopic and pharmacological options, the patient was successfully treated with rituximab. A 78-year-old man developed chronic GI bleeding from caecal and jejunal angiodysplasia. Red cell transfusion was required weekly despite argon plasma coagulation. A diagnosis of AVWS was made from analysis of clotting factors. Therapies including von Willebrand factor concentrate, thalidomide and tranexamic acid were unsuccessful. With failed endoscopic therapy and no viable surgical option, the patient was given intravenous immunoglobulins (IVIGs). Haemoglobin remained stable from this point. The impact on the patient and hospital of attending for IVIG every 3 weeks necessitated consideration to longer-term therapy. After a single course of rituximab, no further blood products, IVIG or rituximab were required. This case is the first to describe the use of rituximab in AVWS-associated angiodysplasia.

  • gastrointestinal bleeding
  • angiodysplasia

https://doi.org/10.1136/flgastro-2018-101116

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    Footnotes

    • Contributors JH wrote the abstract, case summary, discussion and learning points. AK conducted a literature search and wrote the discussion and treatment sections. WA wrote and edited sections of the revised manuscript. AC and FF edited and critically appraised the case report. FF is responsible for the overall content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.