A patient receiving bevacizumab chemotherapy may develop a perforation of the nasal septum. The nasal septum is vulnerable to perforation because the cartilage is avascular and the septum is relatively thin.


Clinical features:

(1) perforation of the nasal septum

(2) history of bevacizumab therapy prior to onset

(3) exclusion of alternative explanations for the septal perforation


Findings that may precede the perforation:

(1) epistaxis

(2) crusting of the nasal mucosa

(3) rhinorrhea or nasal irritation

(4) nasal pain


The risk of nasal perforation may extend to other anti-VEGF targete agents.


Management usually involves an individualized approach in consultation with an ENT specialist. Some patients may continue bevacizumab therapy while others may discontinue it. Early recognition may improve the outcome.


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