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Special Feature
March 7, 2011

Picture of the Month—Quiz Case

Author Affiliations

Samir S.ShahMD, MSCE

Arch Pediatr Adolesc Med. 2011;165(3):275-276. doi:10.1001/archpediatrics.2011.2-a

A 15-year-old girl had red spots on her tongue. The spots had been present for approximately 1 year and bled a few times each month. The bleeding generally lasted for 10 to 15 minutes and stopped with minimal pressure on the lesion. The lesions had not changed color or size. They blanched with pressure. Figure 1shows the lesions on her tongue. She had several similar lesions on her lips (Figure 2).

Figure 1.
Lesions on the tongue.

Lesions on the tongue.

Figure 2.
Lesions on the lips.

Lesions on the lips.

Her medical history was significant for frequent nosebleeds. These occurred spontaneously several times a week and sometimes lasted 20 to 30 minutes. She had no other history of bleeding problems. Her family history was remarkable for a history of recurrent nosebleeds in her father's family, a paternal grandfather who died secondary to a cerebrovascular accident of unknown cause, and a paternal great great grandfather who died of complications of gastrointestinal bleeding. Examination of the patient’s father showed similar lesions on his hands (Figure 3) and in his nose (Figure 4).

Figure 3.
Red spots on the hands of the patient's father.

Red spots on the hands of the patient's father.

Figure 4.
Intranasal examination of the patient’s father.

Intranasal examination of the patient’s father.

What is your diagnosis?