Infantile hemangioma with cleft lip in a term female infant born to a mother with pregnancy-induced hypertension

Abstract

Infantile hemangioma (IH) is the most common benign vascular tumor in infancy, affecting approximately 4–10% of neonates, with a higher prevalence in females and premature infants. Although typically self-limiting, IHs can lead to complications such as ulceration, disfigurement, or functional impairment—particularly when located near vital anatomical structures. This case reports a case of a 40-day-old term female infant presenting with multiple reddish raised lesions over the upper lip and right shoulder, clinically diagnosed as infantile hemangiomas. The infant was born to a mother with pregnancy-induced hypertension (PIH), managed antenatally with labetalol. Examination revealed a central ulcerated lesion on the upper lip and a smaller non-ulcerated lesion over the right shoulder. A congenital cleft lip was also noted, without cleft palate involvement. Systemic evaluations including abdominal and cranial ultrasound, echocardiography, and 12-lead electrocardiogram (ECG) were within normal limits. Topical becaplermin 0.01% gel was applied twice daily for two weeks to promote ulcer healing, followed by oral atenolol at a dose of 0.25 mg/kg/dose twice daily. The treatment was well tolerated, with no adverse effects. Significant regression of both lesions was observed over the following weeks. Although PHACE syndrome was initially suspected due to facial involvement and cleft lip, it was ruled out based on normal neuroimaging and cardiac assessments. This case highlights the successful use of atenolol as a safe and effective alternative to propranolol in the treatment of complicated IHs. Early diagnosis, comprehensive evaluation to exclude syndromic associations, and timely therapy are essential to avoid complications and ensure favorable outcomes.