CLINICAL CASE OF HEREDITARY HEMORRHAGIC ANGIOMATOSIS IN DERMATOLOGICAL PATIENT

Abstract

Osler-Weber-Rendu syndrome or hereditary hemorrhagic angiomatosis is a rare non-skin-specific inherited disorder in an autosomal dominant pattern, that affects more than a million people worldwide, males and females equally. It is caused by a mutation in genes, which encodes the endoglin – a protein that is responsible for the strength of the vascular wall. As a result, microaneurysms are formed everywhere and they can cause hemorrhage, systemic emboli, or heart failure. Clinically this angiomatosis manifests in childhood. In approximately 90% of affected individuals, due to the formation of small, fragile vascular malformations (telangiectases) in the mucous membranes lining the inside of the nose, the first apparent symptom is recurrent nosebleeds. Gastrointestinal or frequent uterine bleeding (hemorrhaging), which affects about 25-30% of patients, usually does not present until the third decade of life, or later and often leads to chronically low levels of iron in the blood and eventually to anemia. After 12 years old affection of skin and mucosal membrane vessels causes the formation of esthetic problems: multiple telangiectasias distort the appearance of a person. The diagnosis confirmation does not require complex research manipulations, nevertheless, sometimes it is difficult to differentiate from the multiple spider-like nevi in chronic liver diseases, multiple senile angiomas, Von Willebrand disease, or CREST syndrome. The use of dermoscopy is not crucial, however, we can use it as a complementary tool for diagnosis verification. Case presentation. We present a clinical case of Osler-Weber-Rendu syndrome to draw the attention of all specialties doctors, as it is not an aesthetic problem, but a serious, sometimes life-threatening, systemic disease. A 46-year-old woman applied to a cosmetology clinic with multiple red vascular elements scattered over the entire surface of the body, causing a visible cosmetic defect. Despite the presence of manifestations of the disease in the anamnesis (frequent nosebleeds, persistent iron-deficiency anemia, excessive uterine bleeding that caused extubation), dermatologists were the first to diagnose this syndrome at such a late age. Objectively numerous spiderweb-like red lesions with different sizes and shapes cover the whole body, even the lips and tongue. Dermoscopic signs are expanded vascular loops and lacune, grouped dots, and clods on a pink background. No pigmented components are visible. Conclusion. Management of such a patient is complex: the patient should be under the close supervision of a family doctor and other organ-specific specialists, who determine appropriate tactics of management. Continuously strengthening the vascular wall, trauma avoidance, and non-using the contraindicated in this disorder medications are the basis. As this syndrome is a hereditary disease, only symptomatic treatment can be offered to the patient. To improve quality of life and prevent life-threatening complications various surgical techniques and laser therapy are applied nowadays. However, target therapy affecting the vascular endothelial growth factor is the modern approach. It is also critical to undergo an appropriate diagnostic screening (Dopplerography, contrast echocardiography, computer tomography, or magnetic resonance angiography) for the timely detection of aneurysms of vessels as well as the prevention of internal bleeding that can lead to serious disability or even mortality.