Successful propranolol treatment of a large size infantile hemangioma of the face causing recurrent bleeding and visual field disruption

Abstract

A 29 days old Pakistani female infant was presented to our outpatient department with two weeks history of a rapidly progressing large size facial hemangioma involving most of the right cheek and right eyelids. The infant was unable to open the right eye. There was also a small hemangioma on the right second toe. Additionally, three similar lesions were found on the right side of the palate and adjoining buccogingival surfaces. The parents were particularly concerned about the explosive progression of the lesions, recurrent bleeding episodes from ulcerated areas of the cheek lesion and complete occlusion of the right eye. Following four weeks therapy with propranolol in a dose of 2 mg/kg/day, the hemangiomas rapidly regressed, the bleeding episodes ceased and the infant started opening the eye.

Keywords: Bleeding; Infantile hemangioma; Propranolol; Visual field.

Fig. 1

The infant at initial presentation with extensive hemangioma involving most of the right cheek and right eyelids. There were five ulcerated, hemorrhagic spots which had been covered with dressings by the parents.

Fig. 2

Three hemangiomatous lesions on the right side of palate and adjacent buccogingival surfaces could be also be visualized as the child cried.

Fig. 3

Small hemangioma was also present on the right third toe.

Fig. 4

Three days after initiation of the propranolol therapy, there was visible alteration in the color of the lesion, softening in texture and the infant could slightly open the right eye.

Fig. 5

There was considerable improvement after completing four weeks therapy.