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85-year-old man with epistaxis.

An 85-year-old man with a medical history notable for monoclonal gammopathy of undetermined significance (MGUS), prostate cancer, bladder cancer, and squamous cell skin cancer presented to the emergency department with periodic epistaxis of 3 to 4 weeks' duration. The bleeding was spontaneous without antecedent trauma. The episodes of epistaxis usually lasted for about an hour. Pressure to the nares would stop the bleeding. The patient noted prolonged bleeding of his gums after brushing his teeth. He denied easy bruising, petechiae, spontaneous hemarthrosis, or rashes. He had experienced fatigue during the past few months with an unintentional weight loss of about 10 kg even though his appetite was normal. He denied new bone or joint pain.