Infant with facial lesions and respiratory distress
A 2-month-old Hispanic girl is transferred by her pediatrician to the emergency department (ED) for evaluation of decreased oral intake, failure to thrive, and large bleeding facial hemangiomas.
The infant started developing hemangiomas at 2 weeks of age, but her parents were reassured by her primary care physician that the hemangiomas would regress over time. However, they continued to grow in size and number on the baby’s face, neck, and upper back. Three weeks prior to her transfer to the ED, the hemangiomas on her upper lip and nose ulcerated. A plastic surgeon debrided the scabs on her nose, but no additional workup was done. For 2 days prior to her transfer, the baby was feeding poorly and breathing laboriously, prompting the concerned parents to seek a higher level of care for the ill child.