Infantile Hepatic Hemangiomas and Hemoglobin SC Disease in a Very Low Birth Weight Premature Infant with Pulmonary Hypertension and Congestive Heart Failure: A Case of Multifactorial Etiology

Infantile hepatic hemangiomas (IHHs) are common benign tumors in infants that may have an amplifying effect leading to significant complications, particularly in the context of extreme prematurity. We are reporting a case of a 9-month-old female infant with multiple IHHs, birth weight 700 grams, and an intricate medical history, including extreme prematurity, multiple comorbidities, and hemoglobin SC disease. He presented with vague abdominal symptoms that rapidly escalated to alarming neurological issues and a life-threatening pulmonary hypertensive crisis necessitating veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Imaging revealed multiple liver lesions consistent with IHHs and severe pulmonary hypertension. Remarkably, treatment with oral propranolol and methylprednisolone yielded profound clinical improvements. Follow-up imaging revealed striking enhancements in liver appearance, with no discrete hyperechoic nodules evident on abdominal ultrasound. The patient continues to receive sildenafil for persistent pulmonary hypertension. This case underscores the importance of vigilant monitoring and a multidisciplinary approach in managing high-risk infants grappling with IHHs, associated complications, and concurrent hematological disorders, demonstrating the possibility of positive outcomes despite significant medical challenges.