Gastrointestinal (GI) hemorrhage occurs in 15% of patients with systemic sclerosis (SSc).1 Although cutaneous telangiectasia is common in SSc, mucosal telangiectasias can also occur and may involve the GI tract, including gastric antral vascular ectasia and telangiectasias or angiodysplasia of the stomach and small intestine.2,3 Colonic telangiectasias, though rare, have been reported.1,3
An 86-year-old woman presented with irregular rectal bleeding for 1 week. Seventeen years prior, she was diagnosed with SSc, based on the presence of skin thickening of the fingers, Raynaud phenomenon (RP), abnormal nailfold capillaries, and anticentromere antibodies. There were no cutaneous telangiectasias. She had been treated with bosentan for digital ulcers of the feet and pulmonary arterial hypertension (PAH). On presentation, she was afebrile and hemodynamically stable, with mild respiratory compromise. Laboratory examination showed hemoglobin 9.2 g/dL, mean cell volume 88.8 fL, transferrin saturation 13.2%, and ferritin 33 ng/mL. Colonoscopy revealed diffuse telangiectasias throughout the entire colon (Figures 1A,B). A diagnosis of colonic bleeding secondary to telangiectasia due to SSc was made. Given the extensive nature and the absence of active bleeding, endoscopic cauterization was deferred. The patient was managed conservatively with iron supplementation.
(A,B) The endoscopic images of the colon demonstrate a diffuse, reticular vascular pattern under white light.
Colonic telangiectasias can be managed with argon plasma coagulation or bipolar cautery. Iron supplementation might be indicated for diffuse lesions.1,3 RP, abnormal nailfold capillaries, digital ulcers, and PAH reflect a unified vasculopathic spectrum in SSc. Telangiectasia is also recognized within this vascular framework.4,5 Accordingly, the gastric mucosal vasculopathy observed in this case may represent another manifestation of this shared vascular phenotype.
Footnotes
CONTRIBUTIONS
YO, RS, YS: conception, design, acquisition of data, patient management. KO: interpretation of data. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
FUNDING
The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
COMPETING INTERESTS
The authors declare no conflicts of interest relevant to this article.
ETHICS AND PATIENT CONSENT
Institutional review board approval was not required under the policies of the authors’ institutions. Patient consent was obtained using a standard consent form, which was documented in the patient’s hospital record.
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