Multiple Choice: ERYTHEMATOVIOLACEOUS MACLES ON TONGUE

Abstract

A 59-year-old woman, originally from San Miguel de Tucumán, with a history of multiple hospitalizations since 2019 for anemic syndrome and heart failure, without a definitive diagnosis. She was admitted to the guard in poor general condition, asthenic, adynamic, with generalized cutaneous-mucous pallor, edema of the lower limbs, upper gastrointestinal bleeding and epistaxis. In the facial region she presented multiple brownish papules with a rough surface, rounded, with well-defined edges (Photo 1). On the dorsum of the tongue, short fissures distributed evenly, and multiple macules and erythematopurpuric papules of years of evolution (Photo 2). During her hospitalization in the Medical Clinic room, a Dieulafoy lesion with active bleeding was evident in upper digestive video endoscopy. Polypoid lesions at the level of the sigmoid and cecum in colonoscopy. She presented non-reactive serologies and tumor markers within normal values. In the abdominal tomography: diffusely enlarged liver with a non-homogeneous structure, marked increase in the diameter of the inferior vena cava and suprahepatic veins, so a hepatosplenic Doppler ultrasound was requested where multiple enlarged, tortuous intrahepatic arterial routes were recognized. and with high flow rate.