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Subglottic hemangioma treated with interferon alpha 2A
G Kontzoglou1, S Triaridis, G Noussios
1Department of Otolaryngology Head and Neck Surgery, Hippokratio General Hospital, Thessaloniki, Greece.
Insights
Infantile subglottic hemangioma, a rare airway obstruction, can be effectively treated with steroids and interferon alfa-2a. This combination therapy led to significant remission in an infant, avoiding the need for tracheostomy.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Vascular Malformations
Background:
- Infantile subglottic hemangioma is a congenital vascular malformation causing progressive airway obstruction.
- Symptoms typically manifest in early infancy as stridor and croup-like illness due to lesion enlargement.
Observation:
- A 3-month-old infant presented with respiratory distress.
- Endoscopic examination revealed a subglottic hemangioma on the left lateral wall.
Findings:
- The infant received a combination of dexamethasone and interferon alfa-2a.
- Significant improvement in symptoms and impressive remission of the hemangioma were observed within 3 months.
Implications:
- Interferon alfa-2a offers an effective, non-surgical treatment option for subglottic hemangiomas.
- Conservative management, including medical therapy, is preferred over aggressive interventions due to potential complications.
Abstract:
Infantile subglottic hemagioma is a rare vascular malformation involving the subglottic larynx and although present from birth, symptoms will not be noted until later in infancy (due to tendency to enlarge). Typically presents with a progressive crouplike illness that begins a few weeks after birth and the infant develops inspiratory stridor, which becomes expiratory as the obstruction increases. Although benign lesions which involute spontaneously, they may demand the attention of an ENT surgeon to maintain a secure airway. We report a case of a 3-month-old female patient (full term, normal delivery) who was referred to us for investigation of respiratory distress. Endoscopic examination revealed a hemangioma at the left lateral wall of the subglottic larynx while the rest of the airway was normal. The infant was treated with a combination of steroids (dexamethazone 0.5 mg x 3 per os) and interferon A-2a (650.000 IU subcutaneously, every other day, for 12 months) and had fast improvement of her symptoms. Repeated endoscopy 3 months after the diagnosis reveal impressive remission of the subglottic hemangioma. Throughout the years, a variety of treatments have been proposed and utilised for subglottic hemangioma. Interfron 2-alpha, drug acting by interference with angiogenesis, is very effective in treating subglottic hemangiomas without the need for tracheostomy. Its side effects are generally not serious. As congenital subglottic hemangiomas have tendency towards spontaneous regression, conservative treatment seems more appropriate compared to more aggressive treatment that carry substantial risks of long term complications.