The name blue rubber bleb nevus syndrome is derived from the rubber-like consistency on palpation of the cutaneous lesions. They present as dark blue compressible papules that may or may not be painful [1] and measure from millimeters to centimeters in diameter. These cutaneous nevi do not bleed spontaneously but are fragile and may be flat, elevated or pedunculated.

Patients have nonspecific complaints like asthenia caused by chronic hemorrhage due to acute blood loss following hematemesis, rectal bleeding or melena, hemoptysis, hematuria, epistaxis or nasal bleeding [2] or signs of hemothorax or hemopericardium. Occipital lobe bleeding associated with blue rubber nevus syndrome has been described, leading to blindness [3]. Similar lesions may be encountered in any [4] type of tissue: glandular, muscular, genital, bone, heart, lung, renal, pericardium and peritoneum [5] [6].

Nevi are usually present and diagnosed at birth and have a natural tendency to grow and multiply or even invade neighboring structures as the child grows older, but malignant transformation has not been reported yet. Nevi located close to bones may cause bowing deformity, while those in the neighborhood of joints may lead to hemarthrosis and affect joint mechanics. Their histological nature, consisting of dysplastic veins with abnormal walls may cause consumption coagulopathy that exacerbates blood loss.

• Anemia

  This disease is often associated with sideropenic anemia and occult bleeding. We report the case of chronic severe anemia in an old patient under oral anticoagulation treatment for chronic atrial fibrillation. [ncbi.nlm.nih.gov]

• Soft Tissue Mass

  He presented with a rubber-like soft-tissue mass in the left knee and the right side of the neck, recurrent pain, and fixed flexion contracture of the knee. [ncbi.nlm.nih.gov]

  Soft tissue masses not specific for hemangiomas can be revealed by CT scans. Selective arteriography and scintillography are useful in cases of active bleeding. In our case, the massive bleeding indicated surgical treatment. [scielo.br]

  Physical examination indicated that the blue-black rubber-like soft-tissue masses ranging from 5 mm to 5 cm were on the neck, upper and lower limbs, chest walls, and back (Fig. 1 a). [karger.com]

  Download figure Open in new tab Download powerpoint Figure 3 - Post-contrast coronal MR of the head and neck shows extensive scalp, neck, upper chest and posterior para-spinal lobulated T2 hyper-intense soft tissue mass lesions suggestive of soft tissue [nsj.org.sa]

• Lesion of the Tongue

  Figure 2: Clinical photograph showing lesions in the left lateral border of tongue Click here to view Figure 5: Clinical photograph showing lesions in the posterior palate and ventral tongue Click here to view In 1860, Gascoyen first described the association [jiaomr.in]

• Vascular Disease

  Abstract Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital vascular disease associated with important morbidity and non-insignificant risk of mortality in cases of severe gastrointestinal or neurological involvement. [ncbi.nlm.nih.gov]

  主要主题词： Esophagus; Gastrointestinal Neoplasms; Nevus, Blue; Skin Neoplasms; Vascular Diseases [paper.medlive.cn]

  It is a congenital vascular disease with various phenotypic patterns. BRBNS is most common in childhood and adolescence, with only a few cases occurring in adults. [news-medical.net]

• Enophthalmos

  A 27-year-old white woman presented with enophthalmos in the right eye. The visual acuity was 20/20 in both eyes. External examination showed 7 mm of enophthalmos of the right eye with deepened superior palpebral sulcus compared with the left eye. [ncbi.nlm.nih.gov]

  Multiple orbital venous malformations presenting with enophthalmos in a patient with presumed blue rubber bleb nevus syndrome. Ophthal Plast Reconstr Surg. 2008 Jul-Aug;24(4):331-4. DOI: 10.1097/IOP.0b013e31817d027a 11. [egms.de]

  Multiple orbital venous malformations presenting with enophthalmos in a patient with presumed blue rubber bleb nevus syndrome. [eyewiki.aao.org]

  Neurologic examination showed right enophthalmos and ptosis, which had been present from early childhood. Motor and sensory findings were normal. [ajnr.org]

Clinical examination may reveal signs of chronic or acute posthemorrhagic anemia or of other complications like volvulus, bowel infarction or intussusception. Mobility may be impaired due to the extension of the lesion inside the joint [7] or due to spinal cord compression [8]. Patients may exhibit dyspnea caused by severe anemia or recurrent thromboembolism and pulmonary hypertension [9] or cyanosis induced by pulmonary stenosis [10].

Workup should include a complete blood count, serum iron levels, a stool sample for occult blood and a urine sample that may detect hematuria.

Skeletal and articular involvement is diagnosed using simple X-rays and may include focal lytic defects or cortical remodeling [11]. The extent of gastrointestinal lesions is best evaluated using superior digestive endoscopy or colonoscopy, while magnetic resonance imaging [12], computer tomography [13] and Technetium-99 scintigraphy [14] detect extracutaneous lesions and bleeding. Magnetic resonance imaging is especially useful in diagnosing liver, spleen and pancreatic lesions, while capsule endoscopy is emerging as an alternative to evaluate gastrointestinal nevi [15]. This is particularly useful since barium studies, the cheaper and more widely accessible alternative only shows polypoid structures and is unable to differentiate between polyps and nevi, creating confusion.

Visceral angiography is not usually indicated, unless performed for other reasons in the same area, despite the fact that it might offer valuable information during the venous phase.

If the extent of the disease is not easily appreciated using noninvasive measures, an exploratory laparoscopy should be performed, especially since this could limit the area of the small bowel to be resected.

• Multiple Pulmonary Nodules

  We report the case of a 37-year-old woman, with known BRBNS, who acquired an intractable cough with a radiograph revealing multiple pulmonary nodules. [ncbi.nlm.nih.gov]

• Microcytic Anemia

  Blue Rubber Bleb Nevus Syndrome: Laser Photocoagulation of Colonic Hemangiomas in a Child with Microcytic Anemia. Pediatric Dermatology, Vol. 9, Issue. 2, p. 91. CrossRef Google Scholar Oranje, Arnold P. 1986. Blue Rubber Bleb Nevus Syndrome. [cambridge.org]

  Morris L, Lynch PM, Gleason WA Jr, et al: Blue rubber bleb nevus syndrome: laser photocoagulation of colonic hemangiomas in a child with microcytic anemia. Pediatr Dermatol. 1992;9(2): 91-4. INTERNET Cherpelis BS. [rarediseases.org]

  Nevi in the intestines can bleed spontaneously and cause anemia or more serious complications. Other symptoms vary depending on the organ affected. [rarediseases.info.nih.gov]

There are currently no effective treatments for BRBNS. Here, we report a case of successful treatment with a small dose of sirolimus of a BRBN patient with a de novo gene mutation. [ncbi.nlm.nih.gov]

Some patients also receive treatment due to cosmetic problems[ 10, 13, 14, 33 ]. The treatment of GI BRBNS is determined by the extent of intestinal involvement and severity of the disease. [doi.org]

What Are the Treatment Options for Blue Rubber Bleb Nevus Syndrome? The treatment should be recommended according to the severity of the blue rubber bleb nevus syndrome. [icliniq.com]

Prognosis and Treatment The prognosis of BRBN is dictated by the extent of intestinal involvement and the presence of other organ involvement. [ncbi.nlm.nih.gov]

Rarely, CNS involvement can be fatal. [11] The prognosis for blue rubber bleb nevus syndrome (BRBNS) depends on the extent of visceral organ involvement and complications related to the degree of symptoms. [emedicine.com]

The etiology of blue rubber bleb nevus syndrome (BRBNS) remains unknown. [5] The literature suggests that this condition occurs sporadically. [5, 6] A few reported cases have been associated with an autosomal dominant inheritance pattern, for which a [emedicine.com]

Etiology Underlying etiology is not known. BRBNS appears to be a sporadic event (although a small number of autosomal dominant cases has been reported). [dermatologyadvisor.com]

In addition, we review the available literature on the epidemiology, clinical features, associated conditions, diagnosis and treatment. [ncbi.nlm.nih.gov]

A world wide website was established to determine the epidemiology, natural history, and clinical aspects of BRBNS. Results: 35 individuals with the diagnosis of BRBNS responded to the website. Only 20 fulfilled the definition of BRBNS. [nature.com]

Summary Epidemiology More than 200 cases have been published so far, but prevalence is unknown. [orpha.net]

The detailed clinical, endoscopical and histopathological description is given as a wide range of differential diagnosis of vascular lesions based on pathophysiology and updated classification of vascular lesions. [termedia.pl]

The disease shows no predilection for gender.[5] Cutaneous manifestations typically present at birth or within early childhood while visceral involvement typically manifests in early adulthood.[3] Etiology and Pathophysiology The etiology and pathophysiology [eyewiki.aao.org]

Goodpasture syndrome: pathophysiology, diagnosis, and management. Nephrol Nurs J 2001;28(3):305-12. Jóźwiak L, Orłowska-Kowalik G, Książek A. Zespół Goodpasture’a współ- istniejący z nieswoistym zapaleniem jelit u 28-letniej kobiety. [ojs.pum.edu.pl]

From germline towards somatic mutations in the pathophysiology of vascular anomalies. Hum Mol Genet. 2009 Apr 15;18(R1):R65-74. [PMC free article: PMC2657941] [PubMed: 19297403] 14. [ncbi.nlm.nih.gov]

The patient was treated with octreotide to prevent rebleeding. During the 12 months of treatment he had no gastrointestinal bleeding episodes or anaemia. Then repeat capsule endoscopy showed that the small bowel vascular lesions were unchanged. [ncbi.nlm.nih.gov]

Current medical research has not established a way of preventing Blue Rubber Bleb Nevus Syndrome If there is a family history of BRBNS, then genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing [dovemed.com]

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2. Esposito C, Giurin I, Farina A, et al. Blue rubber bleb nevus: an uncommon cause of intestinal intussusception. Eur J Pediatr. 2012;171(7):1139-1140.
3. Huang W, Rhodes A. A Case of Blue Rubber Bleb Nevus Syndrome with Gastrointestinal and Central Nervous System Involvement. Pediatr Dermatol. 2012;29(4):524-525.
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8. Garen PD, Sahn EE. Spinal cord compression in blue rubber bleb nevus syndrome. Arch Dermatol. 1994;130(7):934-935.
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10. Singal A, Vohra S, Sharma R, et al. Blue Rubber Bleb Nevus Syndrome with Musculo-skeletal Involvement and Pulmonary Stenosis. Indian Pediatr. 2016; 53(6):525-7.
11. McCarthy JC, Goldberg MJ, Zimbler S. Orthopaedic dysfunction in the blue rubber bleb nevus syndrome. J Bone Joint Surg Am 1982;64:280 –283.
12. Shannon J, Auld J. Blue rubber bleb naevus syndrome associated with cortical blindness. Australas J Dermatol. 2005;46 (3):192-5.
13. Senturk S, Bilici A, Miroglu TC, Bilek SU. Blue rubber bleb nevus syndrome: imaging of small bowel lesions with peroral CT enterography. Abdom Imaging. 2011;36(5):520-523.
14. Yarlagadda R, Menda Y, Graham MM. Tc-99m red blood cell imaging in a patient with blue rubber bleb nevus syndrome. Clin Nucl Med. 2008;33(5):374-376.
15. Lewis BS, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study. Gastrointest Endosc 2002; 56:349 –353.