Renal Hemosiderosis with Bevacizumab Induced Thrombotic Microangiopathy in a Patient with Hereditary Hemorrhagic Telangiectasia

Bevacizumab has become a frequently used therapeutic option for bleeding complications in hereditary hemorrhagic telangiectasia (HHT). Renal limited thrombotic microangiopathy is a welldocumented complication of Bevacizumab therapy. We present an unusual case of Bevacizumab induced thrombotic microangiopathy complicated by glomerular predominant renal hemosiderosis in a patient with HHT-associated bleeding requiring numerous blood and iron transfusions. As most patients with HHT are likely to receive multiple transfusions with many of them also on bevacizumab as maintenance therapy, this case highlights a possible combined toxicity that may complicate the management of these patients.