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Chen LC, Yeung CY, Chang CW, Lee HC, Chan WT, Jiang CB, Chang SW. Blue Rubber Bleb Nevus Syndrome (BRBNS): A Rare Cause of Refractory Anemia in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010003. [PMID: 36670554 PMCID: PMC9856356 DOI: 10.3390/children10010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Refractory anemia is not uncommon in pediatric patients, and anemia caused by gastrointestinal tract bleeding should always be kept in mind. Aside from infection or intestinal malrotation related bleeding, vascular malformation should also be considered. Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder consisting of multiple venous malformations. Lack of experience in pediatric BRBNS might lead to delayed diagnosis or misdiagnosis. Herein, we report a case of an eleven-year-old boy with recurrent pallor appearance and weakness diagnosed with BRBNS. After a thorough examination, he was treated with endoscopic polypectomy, and further iron supplements and folic acid. He is now under regular follow-up at our outpatient department. No complication is noted for six months. BRBNS is a rare venous malformation syndrome that mostly involves skin and the gastrointestinal tract. Multidisciplinary approach should be arranged for diagnosis and management. Up to date, no consensus for BRBNS treatment has been reached. Management usually depends on clinical symptoms and severity of damage of involved organs. The options of treatment include conservative, medical, endoscopic, and surgical management.
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Affiliation(s)
- Liang-Chun Chen
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242, Taiwan
| | - Chun-Yan Yeung
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hsinchu Municipal MacKay Children’s Hospital, No. 690, Sec. 2, Guangfu Rd., East Dist., Hsinchu City 300044, Taiwan
- Correspondence: ; Fax: +886-3-6110900
| | - Chen-Wang Chang
- Department of Hepatology and Gastroenterology, MacKay Memorial Hospital, Taipei City 104, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Szu-Wen Chang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mackay Memorial Tamshui Branch Hospital, New Taipei City 251, Taiwan
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Daviskiba S, Shuman H, Ayyash M, Vadlamudi G, Smietana S, Goyert G. A multidisciplinary approach to caring for a pregnant patient with blue rubber bleb nevus syndrome: A case report. Case Rep Womens Health 2022; 34:e00403. [PMID: 35299692 PMCID: PMC8920868 DOI: 10.1016/j.crwh.2022.e00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by recurrent, multifocal venous malformations throughout the skin, soft tissue, and numerous internal organs. Pregnant women with BRBNS are at high risk of morbidity and mortality, and thus their care requires careful planning and surveillance. This report highlights the case of a 21-year-old woman, gravida 1, para 0, with BRBNS who was cared for by a multidisciplinary team of providers in obstetrics, maternal-fetal medicine, obstetric anesthesia, hematology, dermatology, gastroenterology, and otorhinolaryngology. The report provides a comprehensive guide to the multidisciplinary management of pregnancy and delivery for patients with BRBNS. Blue rubber bleb nevus syndrome increases morbidity and mortality in pregnancy. Management requires a multidisciplinary approach to prenatal and intrapartum care. Careful planning and surveillance by multiple specialties is recommended.
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Tshering S, Dorji N, Youden S, Wangchuk D. Maternal sirolimus therapy and fetal growth restriction. Arch Clin Cases 2021; 8:19-24. [PMID: 34754935 PMCID: PMC8565690 DOI: 10.22551/2021.31.0802.10180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fetal growth restriction associated with continued maternal sirolimus therapy in pregnancy has not been reported. We hereby present a case of maternal sirolimus therapy resulting in fetal growth restriction and propose a multi-hit model. This hypothetic model is based on inhibition of mTOR signaling pathway and epigenetic modulation. This case report adds to the paucity of literature on continued monotherapeutic maternal sirolimus in pregnancy and its adverse fetal effects.
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Affiliation(s)
- Sangay Tshering
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics & Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Youden
- Faculty of Post Graduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Dorji Wangchuk
- Faculty of Post Graduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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Hult M, Halldorsdottir H, Vladic Stjernholm Y, Hein A, Jörnvall H. Blue Rubber Bleb Nevus Syndrome in the Obstetric Patient: A Case Report of Anesthetic Implications and Management. A A Pract 2021; 15:e01517. [PMID: 34428772 DOI: 10.1213/xaa.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic syndrome characterized by venous malformations usually found in the skin and visceral organs. To date, 11 case reports describing BRBNS during pregnancy have been published. To our knowledge, this is the first report describing intracranial, airway, epidural, and birth canal involvement of venous malformations in the same parturient. Key lessons learned include clinical presentation, workup, team management, and care of obstetric patients with this disorder.
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Affiliation(s)
- Martin Hult
- From the Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Halla Halldorsdottir
- Department of Anesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Vladic Stjernholm
- Department of Women's and Children´s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Hein
- Department of Anesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden
| | - Henrik Jörnvall
- From the Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Hu Z, Lin X, Zhong J, He Q, Peng Q, Xiao J, Chen B, Zhang J. Blue rubber bleb nevus syndrome with the complication of intussusception: A case report and literature review. Medicine (Baltimore) 2020; 99:e21199. [PMID: 32664167 PMCID: PMC7360318 DOI: 10.1097/md.0000000000021199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Blue rubber bleb nevus syndrome (BRBNS) is an extremely rare disorder characterized by multifocal venous malformations involving various organs such as the skin and gastrointestinal tract. Severe complications of BRBNS, such as intussusception, volvulus, and intestinal infarction are rarer and require surgery. This report describes a 33-year-old male of BRBNS complicated with intussusception that was successfully diagnosed and treated with surgery. PATIENT CONCERNS A 33-year-old Chinese man presented with persistent, colicky pain accompanied by nausea, abdominal distension, and dizziness. The patient presented with sporadic bluish nodules on his skin involving his head, neck, thorax, abdomen, and planta pedis. DIAGNOSES BRBNS with the complication of intussusception. INTERVENTIONS An emergency laparotomy was performed, and postoperative management included blood transfusions and oral iron supplementation for 2 weeks. OUTCOMES The patient's postoperative course of hospitalization was uneventful. During the 4-month follow-up, the patient showed no signs of intussusception recurrence. LESSONS Patients diagnosed with BRBNS who present with acute abdominal pain and distension should raise suspicion for the presence of intussusception, which requires emergent surgical intervention.
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Affiliation(s)
- Zeming Hu
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Xuan Lin
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Jianing Zhong
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Qingfang He
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Qin Peng
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Jianbo Xiao
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Bin Chen
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Jianhong Zhang
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
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Liu YL, Jiang YP, Du J. Pulmonary embolism during pregnancy in a case of blue rubber bleb nevus syndrome. Chin Med J (Engl) 2019; 132:1499-1501. [PMID: 31205114 PMCID: PMC6629321 DOI: 10.1097/cm9.0000000000000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yan-Li Liu
- Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
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Galey J, Bharadwaj S, Crimmins S, Hong CM, Malinow AM. Anesthetic Implications of an Obstetric Patient with Blue Rubber Bleb Nevus Syndrome. ACTA ACUST UNITED AC 2016; 6:146-9. [PMID: 26579613 DOI: 10.1213/xaa.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Blue rubber bleb nevus syndrome, a syndrome of multifocal venous malformations, has been reported rarely during pregnancy. This syndrome has been associated with airway lesions in some patients and neuraxial abnormalities in other patients. We report the anesthetic and obstetric management of a patient with an extensive distribution of both airway and neuraxial lesions.
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Affiliation(s)
- Jessica Galey
- From the Departments of *Anesthesiology and †Obstetrics/Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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Jin XL, Wang ZH, Xiao XB, Huang LS, Zhao XY. Blue rubber bleb nevus syndrome: A case report and literature review. World J Gastroenterol 2014; 20:17254-17259. [PMID: 25493043 PMCID: PMC4258599 DOI: 10.3748/wjg.v20.i45.17254] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/21/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations and hemangiomas in the skin and visceral organs. The lesions often involve the cutaneous and gastrointestinal systems. Other organs can also be involved, such as the central nervous system, liver, and muscles. The most common symptoms are gastrointestinal bleeding and secondary iron deficiency anemia. The syndrome may also present with severe complications such as rupture, intestinal torsion, and intussusception, and can even cause death. Cutaneous malformations are usually asymptomatic and do not require treatment. The treatment of gastrointestinal lesions is determined by the extent of intestinal involvement and severity of the disease. Most patients respond to supportive therapy, such as iron supplementation and blood transfusion. For more significant hemorrhages or severe complications, surgical resection, endoscopic sclerosis, and laser photocoagulation have been proposed. Here we present a case of BRBNS in a 45-year-old woman involving 16 sites including the scalp, eyelid, orbit, lip, tongue, face, back, upper and lower limbs, buttocks, root of neck, clavicle area, superior mediastinum, glottis, esophagus, colon, and anus, with secondary severe anemia. In addition, we summarize the epidemiology, clinical manifestations, diagnosis, differential diagnosis and therapies of this disease by analyzing all previously reported cases to enhance the awareness of this syndrome.
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Wang Y, Zhao X, You X. Blue rubber bleb nevus syndrome coexisted with intestinal intussusception: a case report. Pan Afr Med J 2014; 17:212. [PMID: 25237409 PMCID: PMC4163179 DOI: 10.11604/pamj.2014.17.212.3598] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/17/2014] [Indexed: 01/16/2023] Open
Abstract
Blue Rubber Bleb Nevus Syndrome (BRBNS) is an uncommon congenital disorder characterized by sporadic venous malformation which mainly occurs in skin and alimentary canal. Here, we report a BRBNS patient with concomitant intestinal intussusception who diagnosed by intraoperative endoscopy and ultimately managed using surgical resection. A 19-year-old boy was referred to urgent surgery for acute melena and stomachache. He had used to be a long-term iron user for undiagnosed chronic anemia and papules. Abdominal CT on admission demonstrated the presence of intestinal intussusception. The following exploratory laparotomy and intraoperative endoscopy revealed multiple gastrointestinal hemangiomas. The postoperative course was uneventful and pathological examination certified multiple cavernous hemangiomas in the resected gastrointestines.
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Affiliation(s)
- Yuanjie Wang
- Department of Gastroenterology Surgery, Taizhou People's hospital, Taizhou, China
| | - Xiaojun Zhao
- Department of Gastroenterology Surgery, Taizhou People's hospital, Taizhou, China
| | - Xiaolan You
- Department of Gastroenterology Surgery, Taizhou People's hospital, Taizhou, China
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Familial blue rubber bleb nevus syndrome in pregnancy with spinal epidural involvement. Case Rep Obstet Gynecol 2013; 2013:141506. [PMID: 23762681 PMCID: PMC3665244 DOI: 10.1155/2013/141506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 12/20/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations (VMs) of the skin, gastrointestinal tract, and other organs. To date, several cases of sporadic BRBNS involving various parts of the pregnant woman's body have been reported; however, BRBNS in pregnancy with spinal epidural involvement has not been reported. Here, we describe the clinical features and management of familial BRBNS in pregnancy. The patient presented with multiple VMs on her head, neck, floor of the mouth, trunk, leg, foot, and vulva and spinal epidural lesions. The patient's mother and sister also exhibited multiple VMs similar lesions, indicating a familial form of BRBNS. Cesarean section under general anesthesia was performed, and a healthy male neonate was delivered. The mother's postoperative course was uneventful and her VMs decreased in size after delivery. Physicians should consider the possibility of systemic diseases and familial inheritance in cases of VMs.
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