A 35-year-old has spontaneous recurrent bilateral epistaxis, mucocutaneous telangiectasias and a first-degree relative with the same problem. What is the best next management principle?
The Curaçao features strongly suggest HHT. Management extends beyond nasal haemostasis: iron deficiency, pulmonary and cerebral AVMs, hepatic involvement and family risk require coordinated specialist assessment.
A. Treat each bleed in isolation without syndromic assessment: This misses preventable complications from visceral AVMs and chronic iron loss.
B. Assess for hereditary haemorrhagic telangiectasia and screen for visceral arteriovenous malformations: The Curaçao features strongly suggest HHT. Management extends beyond nasal haemostasis: iron deficiency, pulmonary and cerebral AVMs, hepatic involvement and family risk require coordinated specialist assessment.
C. Biopsy a nasal telangiectasia: The diagnosis is clinical/genetic; biopsy can provoke bleeding and is unnecessary.
D. Stop all moisturising treatment: Humidification and topical moisturising measures can reduce mucosal trauma and remain useful.
E. Perform bilateral external-carotid ligation as first-line treatment: This is disproportionate and may compromise later vascular options without addressing systemic disease.
If telangiectasias and family history were absent and bleeding were strictly unilateral, local tumour or vascular pathology would need renewed investigation.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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