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

BMJ Case Rep. 2017 May 16:2017:bcr2017219782. doi: 10.1136/bcr-2017-219782.

Abstract

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.

Keywords: Congenital disorders; Global Health; Hemangioma; Pharmacology and therapeutics.

Publication types

  • Case Reports

MeSH terms

  • Aortic Coarctation / diagnostic imaging
  • Diagnosis, Differential
  • Eye Abnormalities / diagnostic imaging
  • Face / blood supply*
  • Face / pathology
  • Female
  • Guatemala / epidemiology
  • Hemangioma / drug therapy*
  • Hemangioma / pathology
  • Humans
  • Infant
  • Magnetic Resonance Angiography / methods
  • Magnetic Resonance Imaging / methods
  • Neurocutaneous Syndromes / diagnostic imaging
  • Propranolol / administration & dosage
  • Propranolol / therapeutic use*
  • Rural Population
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / therapeutic use*

Substances

  • Vasodilator Agents
  • Propranolol

Supplementary concepts

  • PHACE association