Blue rubber bleb nevus syndrome

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Blue rubber bleb nevus syndrome
Blue rubber bleb nevus on the skin
Synonyms	Bean syndrome
Pronounce
Specialty	Dermatology, Gastroenterology
Symptoms	Venous malformations on the skin and internal organs
Complications	Gastrointestinal bleeding, anemia
Onset	Childhood
Duration	Lifelong
Types	N/A
Causes	Genetic mutation
Risks
Diagnosis	Clinical examination, Endoscopy, Imaging studies
Differential diagnosis	Hereditary hemorrhagic telangiectasia, Klippel–Trénaunay syndrome
Prevention
Treatment	Sclerotherapy, Laser therapy, Surgical removal
Medication	Iron supplements, Blood transfusions
Prognosis	Variable, depends on severity
Frequency	Rare
Deaths

Alternate Names

Bean syndrome; Blue rubber bleb nevus; BRBNS

Definition

Blue rubber bleb nevus syndrome is a condition in which the blood vessels do not develop properly in an area of the skin or other body organ (particularly the intestines).

Summary

The malformed blood vessels appear as a spot or lesion called a nevus. The underlying blood vessel malformations are present from birth even though the nevus may not be visible until later in life. The size, number, location, and severity of these malformations vary from person to person. Affected areas on the skin can be painful or tender to the touch and may be prone to sweating (hyperhidrosis). Nevi in the intestines can bleed spontaneously and cause anemia or more serious complications.

Cause

Currently the cause of blue rubber bleb syndrome is not known.

Inheritance

The syndrome is considered sporadic. Someone who is diagnosed with BRBNS likely has a family relative that has other multifocal venous malformations which is a symptom of the disease. Autosomal inheritance of BRBNS has been found in familial cases associated with chromosome 9p, but the majority of cases are sporadic. The disease correlates with an onset of GI complications. It is reported that GI bleeding is the most common cause of death in most cases.

Symptoms

Symptoms and severity of blue rubber bleb nevus syndrome varies greatly from person to person. In general, blue rubber bleb nevus syndrome is characterized by skin spots (nevi) that may be few to hundreds in number. Size tends varies from millimeters to several centimeters in length. These nevi are made of blood vessels and are spongy, meaning they can easily be pressed upon. When pressure is released, they refill with blood and regain their original shape. They tend to be blue but can vary in color and shape. The surface of the nevi may be smooth or wrinkled and they often have a rubbery feel. They do not tend to bleed spontaneously, but are fragile and will bleed if injured. They may be tender to the touch. They may also be associated with increased sweating in the area of the skin legions. The number and size of legions may worsen with advancing age. Nevi may also be found in the intestines (particularly the small intestine) in individuals with blue rubber bleb nevus syndrome. These nevi can bleed spontaneously causing anemia. Most bleeding from the gastrointestinal tract is slow; however, sudden quick bleeding (hemorrhage) is possible. Other serious complications of gastrointestinal legions may include intussusception, bowel infarction, and even death. Blue rubber bleb nevus syndrome can affect other body organs as well. Nevi have been reported in the skull, central nervous system, thyroid, parotid, eyes, mouth, lungs, pleura, pericardium, musculoskeletal system, peritoneal cavity, mesentery, kidney, liver, spleen, penis, vulva, and bladder. Nevi may also put pressure on joints, bones, or feet, which may make walking difficult or limit range of motion. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. 80%-99% of people have these symptoms

• Arteriovenous malformation
• Bone pain
• Cavernous hemangioma(Collection of dilated blood vessels that forms mass)
• Prolonged bleeding time
• Skin rash
• Visceral angiomatosis

30%-79% of people have these symptoms

• Abnormality of coagulation
• Intestinal bleeding
• Subcutaneous nodule(Firm lump under the skin)
• Volvulus

5%-29% of people have these symptoms

• Gastrointestinal infarctions(Death of digestive organ tissue due to poor blood supply)
• Microcytic anemia

Diagnosis

Blue rubber bleb nevus syndrome is difficult to diagnose because of how rare the disease is. Diagnosing BRBNS is usually based on the presence of cutaneous lesions with or without gastrointestinal bleeding and/or involvement of other organs. Cutaneous angiomas are found on the surface of the skin and from the scalp to the soles of feet.The characteristics of the cutaneous lesions are rubbery, soft, tender and hemorrhagic, easily compressible and promptly refill after compression. A physical examination is mostly used to diagnosis cutaneous angiomas on the surface of the skin. Endoscopy has been the leading diagnostic tool for diagnosing BRBNS for those who suffer from lesions in the gastrointestinal tract. The GI tract is illuminated and visualized in endoscopy. Endoscopy also allows immediate therapeutic measures like argon plasma, coagulation, laser photocoagulation, sclerotherapy, or band ligation. Besides physical examination and endoscopy, ultrasonography, radiographic images, CT and magnetic resonance imaging are helpful for detection of affected visceral organs.

Treatment

Treatment of blue rubber bleb nevus syndrome varies depending on the severity and location of the affected areas. Skin spots do not usually require treatment, but some individuals with this condition may want treatment for cosmetic reasons or if the location of the nevus causes discomfort or affects normal function. Bleeding in the intestines may be treated with iron supplements and blood transfusions when necessary.Surgery to remove an affected area of bowel may be recommended for repeated or severe bleeding (hemorrhage).

NIH genetic and rare disease info

• NIH info on Blue rubber bleb nevus syndrome

Blue rubber bleb nevus syndrome is a rare disease.

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