High grade dysplastic rectal adenoma in a young patient with Café-au-lait spots: A case reportAli Hamdan1, Razan Abou Zeid2, Jana Khalil3, Karam Karam4, Elias Fiani5*Medical Doctor, Department of Internal Medicine, University of Balamand, Beirut, Lebanon. Email: [email protected] student, University of Balamand, Beirut, Lebanon. Email: [email protected] student, University of Balamand, Beirut, Lebanon. Email: [email protected] doctor, Department of Gastroenterology, University of Balamand, Beirut, Lebanon. Email: [email protected] Professor, Department of Gastroenterology, University of Balamand, Beirut, Lebanon. Email: [email protected] *CORRESPONDING AUTHORKey Clinical Message: Colorectal cancer screening guidelines typically focus on familial history and age-related risk factors, yet Café-au-lait macules could serve as early indicators for tailored surveillance protocols. This case underscores the importance of considering extracolonic manifestations in young patients presenting with colorectal symptoms. We present a case of a young patient with café-au-lait spots who was diagnosed with rectal tubulo-villous dysplastic adenoma following rectal bleeding.Keywords: Café-au-lait macules; Café-au-lait spots; Tubulo-villous dysplastic adenoma; Extracolonic manifestations; Case report.