The tongue shown here belongs to a 25 year old woman presenting to a primary care doctor. She recently got health insurance because of the new healthcare reform bill. Yay! She has no complaints. She is otherwise healthy, but had a lot of spontaneous recurrent nosebleeds in childhood. She takes no medications. She has a family history of embolic strokes (including one from a deep vein thrombosis in someone without a heart defect), recurrent GI bleeds, and cerebral abscess in every generation of her father's side. She does not smoke or do drugs, and she only drinks occasionally. She lives with her cat and works at the supermarket.
Her physical exam is normal except for the finding shown above and a rectal exam that is positive for occult blood in the stool. Because of that, you send some basic labs which show a microcytic anemia. Wow! This was totally unexpected. You just made an important diagnosis because more people have health insurance and can see a doctor due to the healthcare reform bill.
Challenge: This syndrome has two names, each of which has three words. What is it?
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