title: Anemia Due to Inflammation in an Anti-Coagulated Patient with Blue Rubber Bleb Nevus Syndrome.
abstract: BACKGROUND
  Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by vascular malformations mostly involving skin and gastrointestinal tract. This disease is often associated with sideropenic anemia and occult bleeding.
  
  
  METHODS
  We report the case of chronic severe anemia in an old patient under oral anticoagulation treatment for chronic atrial fibrillation.
  
  
  RESULTS
  At admission, the patient also presented fever and increased laboratory parameters of systemic inflammation (ferritin 308 mcg/L, C-reactive protein (CRP) 244 mg/L). A small bluish-colored lesion over the left ear lobe was observed. Fecal occult blood test was negative as well as other signs of active bleeding. Lower gastrointestinal endoscopy revealed internal hemorrhoids and multiple teleangiectasias that were treated with argon plasma coagulation. Videocapsule endoscopy demonstrated multiple bluish nodular lesions in the small intestine. Unexpectedly, chronic severe anemia due to systemic inflammation was diagnosed in an old anticoagulated patient with BRNBS. The patient was treated with blood transfusions, hydration, antibiotic treatment, and long-acting octreotide acetate, without stopping warfarin. Fever and inflammation disappeared without any acute gastrointestinal bleeding and improvement of hemoglobin levels at three-month follow up.
  
  
  CONCLUSIONS
  This is the oldest patient presenting with chronic anemia, in which BRNBS was also diagnosed. Surprisingly, anemia was mainly caused by systemic inflammation instead of chronic gastrointestinal bleeding. However, we would recommend investigating this disease also in old subjects with mild signs and symptoms.
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonaventura
authors.forename: Luca
authors.initials: L
authors.lastname: Liberale
authors.forename: Nadia
authors.initials: N
authors.lastname: Hussein El-Dib
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.forename: Franco
authors.initials: F
authors.lastname: Dallegri
mesh_terms: D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002908:Chronic Disease; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D018329:Nevus, Blue / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants