Which of the following is the LEAST common cause of epistaxis in India?

Explanation

## Causes of Epistaxis — Epidemiology **Key Point:** Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder and is the LEAST common cause of epistaxis in the general population, including India. ### Common Causes of Epistaxis in India | Cause | Frequency | Notes | | --- | --- | --- | | Trauma / digital manipulation | Very common | Especially in children; nose-picking | | Hypertension | Common | Especially in elderly; posterior epistaxis | | Nasal polyps | Common | Allergic, antrochoanal, inflammatory | | Nasopharyngeal carcinoma | Relatively common | Unilateral epistaxis; Indian subcontinent high-risk region | | Rhinitis (allergic, vasomotor) | Common | Mucosal fragility | | Dry climate / low humidity | Common | Mucosal drying and crusting | | **HHT (Osler–Weber–Rendu)** | **Rare** | Autosomal dominant; recurrent severe epistaxis | | Hemophilia, thrombocytopenia | Rare | Systemic bleeding disorder | **High-Yield:** In India, the most common causes are trauma (especially in children), hypertension (in elderly), and nasal pathology (polyps, tumors, rhinitis). HHT is a rare genetic condition and is the LEAST common cause among the options given. ### Hereditary Hemorrhagic Telangiectasia (HHT) **Clinical Features:** - Autosomal dominant inheritance (mutations in *ENG* or *ALK1* genes) - Recurrent, often severe epistaxis starting in childhood - Mucocutaneous telangiectasias (lips, oral mucosa, fingertips) - Arteriovenous malformations (lungs, liver, brain, GI tract) - Anemia from chronic blood loss **Diagnostic Criteria (Curaçao Criteria):** 1. Spontaneous recurrent epistaxis 2. Mucocutaneous telangiectasias (characteristic sites) 3. Visceral AVMs (pulmonary, hepatic, cerebral, GI) 4. Family history of HHT (Diagnosis requires 3 of 4 criteria) **Clinical Pearl:** Patients with HHT require screening for pulmonary and cerebral AVMs due to risk of stroke and pulmonary hemorrhage. Prophylactic antibiotic coverage is recommended for dental procedures. **Warning:** Do NOT confuse HHT with other bleeding disorders — it is specifically characterized by telangiectasias and AVMs, not coagulopathy.