Her medical history was significant for frequent nosebleeds. These occurred spontaneously several times a week and sometimes lasted 20 to 30 minutes. She had no other history of bleeding problems. Her family history was remarkable for a history of recurrent nosebleeds in her father's family, a paternal grandfather who died secondary to a cerebrovascular accident of unknown cause, and a paternal great great grandfather who died of complications of gastrointestinal bleeding. Examination of the patient’s father showed similar lesions on his hands (Figure 3) and in his nose (Figure 4).