Blue Nodules in a 2-Year-Old Female With Chronic Severe Anemia

A 2-year-old girl with severe transfusion-dependent anemia was found to have vascular skin and mucosal lesions with a strong paternal family history of similar findings. Despite extensive gastrointestinal (GI) evaluation, bleeding remained unexplained until laparoscopy revealed a jejunal vascular mass. Resection and genetic testing confirmed multifocal mucocutaneous venous malformations (VMCM) associated with both germline and second hit somatic TEK mutations. This case underscores the phenotypic spectrum of TEK-related venous malformations, their potential for gastrointestinal involvement and life-threatening bleeding, and the importance of molecular diagnosis in guiding management and differentiating them from related vascular anomalies.