We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

Picture of the Month Quiz

A 15-year-old girl had red spots on her tongue. The spots had been present for approximately 1 year and bled a few times each month. The bleeding generally lasted for 10 to 15 minutes and stopped with minimal pressure on the lesion. The lesions had not changed color or size. They blanched with pressure. Figure 1 shows the lesions on her tongue. She had several similar lesions on her lips.

Her medical history was significant for frequent nosebleeds. They occurred spontaneously several times a week and sometimes lasted 20 to 30 minutes. She had no other history of bleeding problems. There was a history of recurrent nosebleeds and fatal internal hemorrhage in her father's family. Examination of the patient's father showed similar lesions on his nasal mucosa (Figure 2).

Image of lesions on tongue

Figure 1.

Image of lesions on nasal mucosa

Figure 2.

What is your diagnosis?

For a complete discussion please read the Picture of the Month—Quiz Case.