Multiple Mucosal Bleedings in a Patient Receiving Nintedanib

Nintedanib, an inhibitor of growth factor receptors, is recommended by current international guidelines for the treatment of idiopathic pulmonary fibrosis (IPF), a disabling disease characterized by a progressive development of fibrosis and loss of lung function.Unfortunately, however, the use of nintedanib can be accompanied by the occurrence of several adverse events, which can lead to drug discontinuation.This case report presents a patient receiving nintedanib (300 mg/day) for IPF and initially developing epistaxis requiring a reduction of the drug dosage (200 mg/day).A couple of months later, the patient was admitted to the hospital for a single episode of melena, due to a duodenal ulcer, which was successfully treated with injective and thermal therapy, followed by proton pump inhibitors.A couple of days later the patient experienced several episodes of rectal bleeding, and a colonoscopy evidenced diffuse mucosal congestion, fragility, and bleeding on contact with the instrument.Histologically, there was no evidence for inflammatory bowel disease.Systemic steroids and a reduction of nintedanib dosage (100 mg/day) led to a fast resolution of the rectal bleeding.This highlights the need for careful monitoring of IPF patients on nintedanib due to the risk of developing multiple mucosal bleedings.