Rectal Bleeding in a Young Patient with Cavernous Hemangioma and Bone Hypertrophy

A 22-year-old man with history of intermittent rectal bleeding since infancy referred for colonoscopy. His vital signs and lab results included blood pressure: 120/80, pulse rate: 102, hemoglobin 9 g/dL, hematocrit 27%, and serum ferritin 7µg/L. On physical examination, he was pale with a slightly raised deep violet colored lesion ("port-wine") on the flank and cavernous hemangiomas with a verrucous quality around the umbilicus and trunk (figures A, and B). Soft tissue and bone hypertrophy with fused or extra toes were also present on the feet (figure C).