INFANTILE HEMANGIOMAS: A UNIQUE PRESENTATION OF PHACE(S) AND LUMBAR SYNDROME
Main Article Content
Abstract
Infantile hemangiomas are mostly benign tumors of the pediatric age group. We present the case of a 14-year-old female who consulted the Medicine out patients’ department (OPD) of Hayatabad Medical Complex with the chief complaint of severe headache and blurry vision for the last 4 months. The patient had large irregular segmental hemangiomas with bony deformities. Past medical and surgical history was insignificant. Magnetic resonance imaging (MRI) showed finding consistent with cerebellar tonsillar ectopia. The presence of such symptoms helped us in diagnosing her as a case of PHACE(S) syndrome [posterior fossa anomalies (P), hemangiomas (H), arterial anomalies (A), cardiac abnormalities and coarctation of aorta (C), eye abnormalities (E), and the sternal defects (S)] with an unusual presentation of LUMBAR syndrome [Lower body hemangioma and other cutaneous defects, Urogenital anomalies, Ulceration, Myelopathy, Bony deformities, Anorectal malformations, Arterial anomalies, and Renal anomalies]. Diagnosis of such rare cases is important. Proper surgical techniques and use of better medical technology are required to make an early diagnosis. Further studies/case reports around the world would assert our findings that PHACE and LUMBAR can present together in a patient as well.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Kilcline C, Frieden IJ. Infantile hemangiomas: How common are they? A systematic review of the medical literature. Vol. 25, Pediatric Dermatology. Pediatr Dermatol; 2008. p. 168–73.
Hess CP, Fullerton HJ, Metry DW, Drolet BA, Siegel DH, Auguste KI, et al. Cervical and intracranial arterial anomalies in 70 patients with PHACE syndrome. Am J Neuroradiol. 2010 Nov;31(10):1980–6.
Siegel DH. PHACE syndrome: Infantile hemangiomas associated with multiple congenital anomalies: Clues to the cause. Vol. 178, American Journal of Medical Genetics, Part C: Seminars in Medical Genetics. Blackwell Publishing Inc.; 2018. p. 407–13.
Heyer GL. PHACE(S) syndrome. In: Handbook of Clinical Neurology. Elsevier B.V.; 2015. p. 169–83.
Drolet BA, Chamlin SL, Garzon MC, Adams D, Baselga E, Haggstrom AN, et al. Prospective study of spinal anomalies in children with infantile hemangiomas of the lumbosacral skin. J Pediatr. 2010 Nov 1;157(5):789–94.
Iacobas I, Burrows PE, Frieden IJ, Liang MG, Mulliken JB, Mancini AJ, et al. LUMBAR: Association between cutaneous infantile hemangiomas of the lower body and regional congenital anomalies. J Pediatr. 2010 Nov 1;157(5):795-801.e7.
Metry DW. Potential complications of segmental hemangiomas of infancy [Internet]. Vol. 23, Seminars in Cutaneous Medicine and Surgery. Semin Cutan Med Surg; 2004 [cited 2020 Jul 17]. p. 107–15.
Haggstrom AN, Lammer EJ, Schneider RA, Marcucio R, Frieden IJ. Patterns of infantile hemangiomas: New clues to hemangioma pathogenesis and embryonic facial development. Pediatrics [Internet]. 2006 Mar [cited 2020 Jul 17];117(3):698–703.
Nabatian AS, Milgraum SS, Hess CP, Mancini AJ, Krol A, Frieden IJ. PHACE without Face? Infantile hemangiomas of the upper body region with minimal or absent facial hemangiomas and associated structural malformations. Pediatr Dermatol [Internet]. 2011 May [cited 2020 Jul 17];28(3):235–41.
Melnick LE, Yan AC, Licht DJ, Treat JR, Castelo-Soccio L. PHACE syndrome: A retrospective review of 23 patients. Pediatr Dermatol [Internet]. 2014 [cited 2020 Jul 17];31(3):390–2.
Garzon MC, Epstein LG, Heyer GL, Frommelt PC, Orbach DB, Baylis AL, et al. PHACE Syndrome: Consensus-Derived Diagnosis and Care Recommendations. J Pediatr. 2016 Nov 1;178:24-33.e2.
Yu J, Siegel DH, Drolet BA, Blei F, Epstein LG, Metry D, et al. Prevalence and Clinical Characteristics of Headaches in PHACE Syndrome. J Child Neurol [Internet]. 2016 Mar 1 [cited 2020 Jul 17];31(4):468–73.
Kronenberg A, Blei F, Ceisler E, Steele M, Furlan L, Kodsi S. Ocular and systemic manifestations of PHACES (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Cardiac defects and coarctation of the aorta, Eye abnormalities, and Sternal abnormalities or ventral developmental defects) syndrome. J AAPOS [Internet]. 2005;9(2):169–73.
minimal or arrested growth: A retrospective case series. Arch Dermatol [Internet]. 2010 [cited 2020 Jul 17];146(9):971–6.
Martines F, Immordino V. Arteriovenous malformation of the base of tongue in pregnancy: case report. Acta Otorhinolaryngol Ital. 2009;29(5):274–8