A propos d’un hémangiome cutané compliqué traité en ambulatoire

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.