An 80-year-old man with von Willebrandís disease was
admitted with severe melaena. Despite suppletion with
von Willebrand concentrate he continued to be dependent on blood transfusions. Endoscopic examination did not show a bleeding focus. Video capsule endoscopy showed active bleeding from angiodysplasias in the proximal section of the small intestine. Ultimately, treatment with thalidomide was initiated at a dose of 100 mg/day. Soon after starting treatment his stools became normal and his haemoglobin level stabilised. No bleeding problems occurred for 11 months, after which the thalidomide treatment was stopped because of the potential side effects. Two months later he again developed melaena and treatment with thalidomide was restarted with a successful outcome. Trying to lower the dose to 50 mg resulted in rebleeding after three months with stabilisation after increasing the dose to 100
mg again. Monotherapy with thalidomide improves the
clinical picture but may not be sufficient in the long term.
Additional therapy, such as argon plasma coagulation or the use of the novel drug lenalidomide, might be necessary.