A 56-year-old man presented with fatigue and exertional dyspnea for 2weeks, and few episodes of black tarry stools over the last 1month. The patient endorsed recurrent episodes of epistaxis since his mid-20s and intermittent black tarry stools for several years. Family history was remarkable for similar problems in his father and brother. On physical examination, the patient had tachycardia, pallor, and mucosal and skin lesions shown in Fig. 1. Laboratory studies revealed a hemoglobin of 5.8g/dL, mean corpuscular volume of 69fL, and a serum iron profile consistent with iron deficiency.
