Case Challenge #19

History of Present Illness

A 57 year old with HCV, GERD, and chronic anemia presents with years of recurrent epistaxis. He has nosebleeds several times per week that last 10 mins and resolve spontaneously. He also notes generalized weakness, DOE, and chest pressure with exertion. In the past, he complained of dark colored stool. He denies using any nasal medications or drugs. He is not on blood thinners, aspirin or NSAIDs. He otherwise denies cough, SOB at rest, hemoptysis.


PSH: None

SHx: occ ETOH, 30 pack year smoking hx

FHx: Father had recurrent nosebleeds due to an underlying illness but he is unaware of the diagnosis

Meds: Ranitidine and prn tylenol

Allergies: None


Physical Exam

Vitals: 96.7F, 104 bpm, 111/68,  RR 18, 100% RA

HEENT: EOMI, PERRLA, pale conjunctiva and mucous membranes, Nasal cavity with dried blood, no active bleeding seen, no nasal polyps

CV: 2/6 systolic murmur without radiation. Regular tachycardia.

Pulm: CTAB, normal effort, no wheezes/rales/rhonchi

GI: Normal bowel sounds, soft, tender to palpation of lower abdomen and mid-epigastric region, no masses



GI Endoscopy