Infantile Haemangioma in a ‘Beard’ Distribution: A Case Report

Aim: To highlight infantile haemangioma as a possible cause of upper airway obstruction in young infants presenting with stridor particularly when there are associated cutaneous lesions.

Presentation of Case: We report a 10 week-old baby girl admitted into the emergency paediatric unit of the Federal Medical Centre Azare, Nigeria with a 3-week history of a skin lesion initially noticed as a flat discoloured area over the sternal region. It progressively spread to involve the anterior aspect of the neck and chin and became associated with progressive difficulty with breathing. Examination findings revealed a restless, acutely ill child with inspiratory stridor. She had purplish plaques in the areas mentioned above as well as the lower lip and ventral aspect of the tongue. She improved remarkably following intranasal oxygen, intravenous dexamethasone and oral propranolol administration and was discharged after 4 days of admission on oral prednisolone and propranolol.

Discussion: Infantile haemangiomas are benign vascular neoplasms that have a characteristic clinical course marked by early proliferation and followed by spontaneous involution. Infrequently, infantile haemangiomas may impinge on vital structures provoking certain related symptoms. Airway obstruction is an uncommon complication and may be particularly challenging for young infants who are obligate nose breathers. Subglottic haemangiomas are also uncommon compared to the cutaneous forms and may be life threatening with attendant airway obstruction. This was the foremost concern in our patient. Nevertheless, she responded to dexamethasone and propranolol.

Conclusion: It is essential to recognize the association of infantile haemangiomas presenting in a beard distribution with airway obstruction and promptly institute management of respiratory complications.