Infected giant lymphangioma in a child

Abstract

Introduction: Lymphangiomas are rare congenital proliferations of lymphatic system. Complications like infection, hemorrhage, necrosis related to compression in adjacent tissue can be seen during the follow-up of giant lymphangiomas. Herein, we present a child case with infected giant lymphangioma on his right arm. Case Report: A 4.5- year- old girl with the prenatal diagnosis of cystic lymphangioma presented with redness, swelling and hyperemia on her right arm. She was illappeared at admission and had a fever of 38.5°C. There was a diffuse, and marked swelling of the right forearm associated with increased fever and hyperemia and an ulcerated lesion on anterior, and lateral wall of the right hemithorax. Laboratory examination revealed neutrophilic leucocytosis and an increase in acute phase reactants. Ultrasonographic examination was consistent with infected lymphangioma and she was started on ampicillinsulbactam treatment. Mangetic resonance imaging of right exremity, thorax and abdomen revealed multiseptate, hemorhagic and infected macrocystic lymphangioma unrelated with another macrocystic lymphangioma 3 cm in diameter on her right chest. Her fever persisted and her antibiotherapy was switched to teicoplanin and meropenem since her swab sample culture yielded growth of methicillin- resistant coagulase-negative staphylococcus growth. Because of its sclerosing effect intralesional tetracycline was administered after consultation with plastic surgery. Sirolimus (mTOR inhibitor) treatment was started after the control of infection was achieved. Conclusions: Multidisciplinary approach is warranted for children with lymphangiomas since they can be complicated and can accompany genetic syndromes.