A large cervical lymphatic malformation in a neonate successfully treated with Kampo medicine

Abstract

Abstract Introduction: Recently the application of Kampo, or Japanese traditional medicine, to lymphatic malformation (LM) has been reported, but there are no reports of its effects against neonatal LM. We herein report a case of a neonatal huge cervical LM successfully treated with eppikajutsuto and ogikenchuto without tracheostomy or sclerotherapy. Patient concerns: A baby boy with a huge cyst in his right neck was delivered by Caesarean section without a prenatal diagnosis. The cyst extended and slightly compressed the trachea on the 7th day after birth. Diagnosis: The patient was diagnosed with LM by ultrasonography. Interventions: Although we planned sclerotherapy with OK-432 followed by tracheostomy, his parents refused tracheostomy. Therefore, we started the administration of eppikajutsuto (0.5 g/kg/d) on the 26th day of life instead of sclerotherapy. As the cyst was slightly enlarged at the beginning of eppikajutsuto administration, we increased the dose of eppikajutsuto to 0.75 g/kg/d and added ogikenchuto (0.4 g/kg/d), expecting greater regression of the lesion than with the initial regimen. Outcomes: After a few days, the cyst started to diminish in size. Six months later, magnetic resonance imaging showed remarkable regression of the LM without tracheal compression. Lessons: The combination of eppikajutsuto and ogikenchuto was thus found to be effective in the treatment of a neonatal LM. This is the first report to demonstrate that the dose-escalation of eppikajutsuto may therefore be effective without any severe adverse effects, even in neonates.