Argon Plasma Treatment for the Nasal Bleeding Caused by Hereditary Hemorrhagic Telangiectasia

Abstract

A 50-year-old man presented with recurrent epistaxis and iron-deficiency anemia. His mother and niece also experienced recurrent epistaxis, and his grandmother, an uncle and two aunts died from severe epistaxis. He had multiple telangiectasia in the nasal mucosa, soft and hard palate, lip, tongue and conjunctiva. He also had experienced hematomesis, and telangiectasia of the stomach was found by gastroendoscopy. He was diagnosed as hereditary hemorrhagic telangiectasia (HHT), because of his family history, recurrent epistaxis, and multiple telangiectasias. We tried various treatments, such as steroid collunarium to the nose, oral tranexamic acid and anti-inflammatory drugs for epistaxis, but it could not be controlled effectively, and severe daily epistaxis required blood transfusion. Thus, next we used argon plasma for irradiating telangiectasia of nasal cavity under endoscopic observation and obtained good control of the epistaxis. In this report, we present the clinical history and treatment results in this case, review the literature and summarize various treatments for recurrent epistaxis in HHT.