Asunto(s)
Antineoplásicos Inmunológicos/efectos adversos , Bevacizumab/efectos adversos , Enfermedades Duodenales/inducido químicamente , Fístula Intestinal/inducido químicamente , Fístula Vascular/inducido químicamente , Venas Cavas , Anciano , Carcinoma de Células Escamosas/terapia , Terapia Combinada/métodos , Enfermedades Duodenales/diagnóstico por imagen , Femenino , Humanos , Fístula Intestinal/diagnóstico por imagen , Neoplasias del Cuello Uterino/terapia , Fístula Vascular/diagnóstico por imagen , Venas Cavas/diagnóstico por imagenRESUMEN
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.