Blue Rubber Bleb Nevus Syndrome as a rare Cause of Iron Deficiency Anemia: a Case Report and Review of Literature
A 22 years old man was referred to the GI clinic of Afzalpour Hospital for evaluation of IDA. There was no history of frank bleeding including melena, hematemesis or rectal bleeding. History of abdominal pain, prolonged diarrhea and/or constipation, vomiting, flatulence and prolonged fever were negative. Drug history was negative including for non–steroidal anti- inflammatory agents. He has been receiving occasionally intravenous iron during the last three years. He suffered from a vascular mass on right supraclavicular region at birth with gradual enlargement. At the childhood, surgical resection of the mass was performed and histology showed irregular cavernous channels in both cutaneous and subcutaneous tissue compatible with venous malformation. At the age of 15, oral iron intake was started because of IDA. At about the same time, multiple bluish colored nodular lesions appeared on his lower extremities. Familial history was negative for vascular lesions resembling BRBNS and any other remarkable diseases. He was not drug abuser and drug history included only oral and intravenous iron supplementation since 7 years ago. In physical examination he appeared well nourished but pale. Multiple compressible bluish nodules on lower extremities were seen (). These nodules measured from 0.5 to 1.5 cm and tended to refill after compression. Scar of a previous incision was present on the right supraclavicular region (). Otherwise, the physical examination was unremarkable.\nLaboratory findings revealed a hemoglobin level of 10.5 g/dL. Other lab results are shown in . The results of routine laboratory tests were within normal limits. Upper and lower gastrointestinal endoscopy along with duodenal biopsy had been performed 4 years ago and was normal.Serum immunoglobulin A(Ig A) and anti-tissue transglutaminase antibody (TTG) -Ig A levels were also normal.\nIn our center the patient underwent upper and lower GI endoscopy for second time. In upper endoscopy, a bluish vascular lesion with 10 mm diameter and wrinkled surface was seen in proximal part of duodenum ().Colonoscopy also revealed a similar lesion in the descending part of colon (). The patient refused assessment of the small intestine tract.