Infantile hemangiomas are common, benign, and self-limited tumors of infancy. A recent multi-institution study found that 30% of infants experience complications related to their hemangioma.1 Of those seen in tertiary medical centers, 12% require treatment with oral corticosteroids.1 Ulceration, ocular compromise, and risk of permanent disfigurement are the most frequent reasons for intervention. There are no agents approved by the US Food and Drug Administration for the treatment of hemangiomas, but current practice includes the use of high-dose corticosteroids. The beneficial effects of corticosteroids were first described in the 1960s, and despite decades of treatment, the literature consists primarily of case reports and small case series. The effects of steroid administration to such a young patient population have not been systematically evaluated. High-dose corticosteroids are an independent risk factor for the development of Pneumocystis carinii pneumonia (PCP).2 However, most physicians treating infants with oral steroids for hemangiomas do not use antimicrobial prophylaxis. We report the second known case of PCP developing in an infant treated with oral corticosteroids for a hemangioma.
Maronn ML, Corden T, Drolet BA. Pneumocystis carinii Pneumonia in Infant Treated With Oral Steroids for Hemangioma. Arch Dermatol. 2007;143(9):1209-1226. doi:10.1001/archderm.143.9.1224