A propos d’un hémangiome cutané compliqué traité en ambulatoire

Abstract

Cutaneous hemangiomas are benign vascular tumors, they can be complicated by very hemorrhagic ulcers and rarely by infections. Oral treatment with beta-blockers has revolutionized the management of complicated cutaneous hemangiomas. We report a case of a 4-month-old infant with no notable history, who consulted for purulent ulceration of a cutaneous hemangioma in the upper of thorax with fever from 3 days ago. The clinical examination finds a febrile infant at 39°C, the hemangioma of 10 cm large presents a central necrosis (A). The indication of hospitalization for management was indicated, but refused by the parents. The biological assessment revealed a CRP at 124mg/l with hyperleukocytosis at 15700/mm 3 predominantly PNN. We started the outpatient treatment: daily local care of the infected ulceration, oral antibiotic therapy: Amoxicillin + clavulanic acid for 10 days and analgesics (Paracetamol). Faced with the hemorrhagic appearance of the ulceration measuring 3cm large diameter (B), we started the beta-blockers, outpatient, orally, after performing a normal ECG. (1mg/kg/day then 2mg/kg/day in two doses after the 1 st week then 3mg/kg/day the third week). Twice-daily monitoring of capillary blood glucose, blood pressure and heart rate was performed at each dose increase. Clinical improvement was spectacular with significant involution of hemangioma (C) after 2 months of treatment with Propranolol. This observation recalls the importance of the introduction of beta-blockers in front of complicated hemangiomas as well as the possibility of their management on an outpatient basis.