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


ÖZDEMİR Z. C., DÜZENLİ KAR Y., ŞÖHRET N. C., KEBAPÇI M., BÖR Ö.

Drug Discoveries & Therapeutics, vol.11, no.3, pp.161-164, 2017 (ESCI) identifier identifier

  • Publication Type: Article / Case Report
  • Volume: 11 Issue: 3
  • Publication Date: 2017
  • Doi Number: 10.5582/ddt.2017.01025
  • Journal Name: Drug Discoveries & Therapeutics
  • Journal Indexes: Emerging Sources Citation Index (ESCI)
  • Page Numbers: pp.161-164
  • Bursa Uludag University Affiliated: Yes

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 mu U/mL). He was started on sodium levothyroxine 50 mu g 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 mu U/mL despite repeatedly increasing the dose of levothyroxine up to 200 mu g/daily. One month after the initial presentation, his TSH level was reduced to 11.28 mu U/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.