Bevacizumab as Rescue Therapy for GI Bleeding in Hereditary Hemorrhagic Telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by abnormal blood vessel formation, frequently involving the gastrointestinal (GI) tract. GI involvement can result in diffuse mucosal telangiectasis, chronic bleeding, iron-deficiency anemia, and transfusion dependence. Conventional treatments often provide limited benefit in patients with widespread disease. Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has emerged as a potential disease-modifying agent through its anti-angiogenic properties. We report a case of a male patient with genetically confirmed HHT and comorbid pulmonary arterial hypertension who presented with recurrent GI bleeding. The patient had a long-standing history of GI bleeding requiring multiple endoscopic interventions, with findings of arteriovenous malformations throughout the GI tract. Prior management with conventional therapies provided only a transient benefit. The patient subsequently received intravenous bevacizumab induction therapy. Bevacizumab therapy resulted in marked clinical improvement, including hemoglobin stabilization, reduction in overt bleeding, and decreased transfusion requirements. Recurrence of bleeding following therapy discontinuation further supports a direct therapeutic effect. This case contributes to the growing body of evidence that VEGF inhibition is a biologically rational and clinically effective salvage strategy for refractory GI bleeding in HHT. Prospective studies are needed to define optimal dosing, maintenance strategies, and long-term outcomes.