BMJ Case Reports 2017; doi:10.1136/bcr-2017-219782
  • Rare disease

Use of propranolol in a remote region of rural Guatemala to treat a large facial infantile haemangioma

  1. Peter Rohloff3
  1. 1Harvard Medical School, Boston, Massachusetts, USA
  2. 2Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala
  3. 3Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Peter Rohloff, prohloff{at}
  • Accepted 20 April 2017
  • Published 16 May 2017


We present a female infant with a right-sided facial and neck haemangioma, from a remote, resource-poor community in rural Guatemala. She received first-line treatment, propranolol, with marked reduction in tumour size and erythema. Treatment was stopped after 35 weeks due to recurrent diarrhoea and sustained weight loss. Propranolol can be used to safely treat infants with haemangiomas in remote, rural communities if there is adequate follow-up, education and communication. Periocular haemangiomas should be treated promptly to avoid visual impairment. Infants with large facial haemangiomas should be screened for Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac anomalies, and Eye anomalies (PHACE) syndrome, and specialists should be involved. The case also highlights the difficulty of providing treatment for a complex illness when basic health needs, such as food security and water sanitation, are limited.


  • Contributors VG provided clinical care and drafted the manuscript.

    BM provided clinical care and critically revised the manuscript.

    KC critically revised the manuscript.

    PR critically revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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