Grade 4 Epistaxis in a Woman with Metastatic Breast Cancer Treated with Bevacizumab: A Case Report

We describe a 39‑year‑old woman with metastatic breast cancer who had grad e4 epistaxis induced by bevacizumab. The patient visited our outpatient clinic with complaints of a lump in her right breast fatigue dyspnea abdominal distention appetite loss and weight loss of 10 kg over 1 year. Liver dysfunction was detected with elevated levels of aspartate aminotransferase (271 IU L alanine aminotransferase (100 IU L alkaline phosphatase (4205 IU L total bilirubin (2.7 mg dL and direct bilirubin (2.1 mg dL. A secondary liver tumor that occupied most of the liver volume was found and bone metastasis ascites and pleural effusion were also discovered. The Eastern Cooperative Oncology Group performance status was 2. A core needle biopsy of the right breast tumor revealed invasive ductal carcinoma of the breast (nuclear grade 1 that was positive for estrogen receptor and progesterone receptor and negative for human epidermal growth factor receptor 2 overexpression and had a high Ki‑67 score. We chose combination chemotherapy with paclitaxel (80 mg m