Profuse Bleeding From a Pyogenic Granuloma As the First Clue to von Willebrand Disease in a Pediatric Patient

A 12-month-old female presented with a friable, hemorrhagic papule on the right lateral inferior eyelid, clinically consistent with a pyogenic granuloma. Although pyogenic granulomas are known to bleed, the extent of hemorrhage in this case was unusual and occurred after minor trauma. The patient's father, an emergency medicine resident, injected lidocaine with epinephrine and applied pressure at home to control the bleeding. Notably, the patient's mother has a history of von Willebrand disease, prompting concern for an underlying inherited bleeding disorder. The severity of bleeding led to referral to pediatric hematology for further evaluation, including hemoglobin and hematocrit testing. This case highlights an uncommon presentation of a common lesion and emphasizes the importance of recognizing disproportionate bleeding from a common skin lesion as a potential early sign of an undiagnosed coagulopathy in pediatric patients.