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An unusual cause of anaemia
  1. O M P JOLOBE
  1. Tameside and Glossop Community and Priority Services NHS Trust, Department of Medicine for the Elderly, Tameside General Hospital, Fountain Street, Ashton under Lyne, Lancashire OL6 9RW, UK

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    Sir,For the sake of completeness, among the neurological complications listed for haemorrhagic telangiectasia (HHT),1 due account should be taken, not only of cerebral abscess (which may be recurrent),2 but also of meningitis, which may also be recurrent,3 both complications being the sequelae of bypassing of the pulmonary filter by bacteria and septic microemboli, as a consequence of a right to left shunt.4Right to left shunts resulting from congenital disorders such as atrial septal defect can be complicated by recurrent intracranial sepsis well into old age,5 and this possibility makes HHT a potential risk factor for this kind of presentation, even in the elderly.

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