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Case Reports
. 2023 Jul-Aug;13(4):707-712.
doi: 10.1016/j.jceh.2023.02.005. Epub 2023 Feb 15.

Propranolol Monotherapy in Multifocal/Diffuse Infantile Hepatic Hemangiomas in Indian Children: A Case Series

Gautam Ray  1 , Kausik Das  2 , Avik Sarkar  3 , Debarshi Bose  2 , Prasenjit Halder  2
Affiliations
Case Reports

Propranolol Monotherapy in Multifocal/Diffuse Infantile Hepatic Hemangiomas in Indian Children: A Case Series

Gautam Ray et al. J Clin Exp Hepatol. 2023 Jul-Aug.

Abstract

Introduction: Infantile hepatic hemangioma (IHH) is the most common benign liver tumor in children, and multifocal and diffuse tumors often become life-threatening, necessitating therapy. Propranolol is now considered the first choice of therapy with ample data in Caucasian children. We present a series of nine Indian children with multifocal (n = 5) and diffuse (n = 4) IHH treated with propranolol monotherapy.

Methods: This was a retrospective clinical data-based single-center study. Propranolol was used at a median dose of 3.2 mg/kg/day (range 3-3.3 mg/kg/day) for a median duration of 12 months (range 6-32 months).

Results: The presentations of IHH (either in isolation or combination) were hypothyroidism in six patients (diagnosed by elevated serum TSH levels), heart failure in three (diagnosed based on clinical and echocardiographic features), and imaging evidence of macrovascular shunting in two patients. A good response to propranolol monotherapy (with a median dose of 3.2 mg/kg/day for a median duration of 12 months) was observed in eight patients, with a poor response in one. One patient experienced recurrence but responded adequately to propranolol retreatment.

Conclusions: Our data reiterate the excellent response (88.9% responded) and safety profile with propranolol monotherapy in complicated IHH and strengthen the data in Asian (Indian) children. It includes the maximum proportion of complicated IHH treated with propranolol in East and South Asia, and the largest series from India.

Keywords: high-output heart failure; hypothyroidism; infantile hepatic hemangioma; macrovascular shunting; propranolol.

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Figures

Image 1
Graphical abstract
Figure 1
Figure 1
Selected representative images of IHH lesions from the reported patients. MRI, magnetic resonance imaging; CECT, contrast enhanced computed tomography.
See this image and copyright information in PMC

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