New York University Woodhull Medical Center Brooklyn, NY, United States
Rohit Gupta, DO, Gulam M. Khan, MD, MS, FRCS(Ed) New York University Woodhull Medical Center, Brooklyn, NY
Introduction: Thalidomide is notorious for its severe and devastating birth defects it caused decades ago. Its use continues to be controversial, highly regulated, and often avoided as the majority of physicians believe the risks outweigh the benefits. However in the right circumstances, it may be the best tool to treat recurrent small bowel angiodysplasias. We present a unique case of a transfusion dependent patient who finally achieved successful control of her anemia after treatment with thalidomide.
Case Description/Methods: A 78 year old female with multiple co-morbidities including CKD stage III and chronic iron deficiency anemia was admitted for progressive shortness of breath and a hemoglobin of 4 g/dL. She was diagnosed with small bowel angiodysplasias and despite over 15 endoscopic procedures with APC, she continued to have episodes of symptomatic anemia. Over the span of two years, she had ten admissions requiring transfusions and IV iron. Understandably, she refused further endoscopy. Thalidomide and its anti-angiogenesis effects were discussed and the patient was willing to trial 100 mg daily. She is currently 10 months into her treatment and has not required further endoscopy. Furthermore, she has had only one admission for anemia due to non-adherence. There have been no other changes in her management, no major side effects, and repeat Hemoglobin levels have been stable at her baseline of 8 g/dL.
Discussion: Current guidelines recommend endoscopic treatment with APC for small bowel angiodysplasias. However, it is estimated that up to one third of these patients may rebleed thus leading to high rate of readmissions for transfusions and poor quality of life. Alternative medical therapies such as octreotide and bevacizumab are difficult to administer and have limited studies. Thalidomide can be considered a suitable and effective alternative for patients that are transfusion dependent, not of childbearing age, and who have failed multiple endoscopic therapies. Major side effects such as DVT and neuropathy have only been noted in patients with daily doses higher than 100 mg or other conditions such as multiple myeloma. Most importantly, as in our patient, thalidomide has shown to be effective in reducing rates of hospitalization and transfusion dependence. Although unconventional, for the right patient and circumstance the existence of thalidomide as an effective therapy should be stressed to clinicians to expand their toolset and prevent dangerous overuse of endoscopic or surgical treatment.
Rohit Gupta indicated no relevant financial relationships.
Gulam Khan indicated no relevant financial relationships.
Rohit Gupta, DO, Gulam M. Khan, MD, MS, FRCS(Ed). P3024 - The Redemption of Thalidomide: A Case Report on an Overlooked Weapon in Combating Anemia and Recurrent Small Bowel Angiodysplasias, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.