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Drug Discov Ther. 2017 Jul 31;11(3):161-164. doi: 10.5582/ddt.2017.01025. Epub 2017 Jul 25.

Beta blocker and steroid therapy in the treatment of infantile hepatic hemangioendothelioma.

Author information

1
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine.
2
Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine.
3
Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine.

Abstract

Infantile hepatic hemangioendothelioma (IHHE) is the most common benign vascular liver tumor and typically occurs during the first 6 months of life. A 4-month-old male patient presented with abdominal distention. A physical examination revealed massive hepatomegaly. Liver enzyme levels were normal. The alpha fetoprotein level was 1,323 mg/dL (6-1,000). Abdominal magnetic resonance imaging (MRI) showed multiple, well-defined and hyperintense nodular lesions in the liver. MRI findings suggested IHHE. The thyroid stimulating hormone (TSH) level was high (177.2 µU/mL). He was started on sodium levothyroxine 50 μg daily. The patient has hypoxemia due to abdominal distention during the follow-up period. Oral methylprednisolone therapy was started at a dose of 2.5 mg/kg/dose, and propranolol at a dose of 1 mg/kg/dose, bid. Fifteen days later his TSH level remained elevated at 212.3 μU/mL despite repeatedly increasing the dose of levothyroxine up to 200 μg/daily. One month after the initial presentation, his TSH level was reduced to 11.28 µU/mL. We observed a marked improvement in abdominal distention and respiratory distress within 15 days and an average reduction of 50% in the lesion diameters after a month. Despite its benign nature, IHHE may lead to development of complications. Steroid and propranolol treatment may be useful in in the management of emergency complications.

KEYWORDS:

Infantile hepatic hemangioendothelioma; methylprednisolone; propranolol

PMID:
28652510
DOI:
10.5582/ddt.2017.01025
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