Platelet-rich fibrin therapy for skin necrosis caused by intravenous extravasation of arginine hydrochloride: a case report and literature review

Arginine hydrochloride, widely used in growth hormone stimulation tests, can cause local swelling and, rarely, full-thickness skin necrosis, usually managed conservatively or with skin grafting. Platelet-rich fibrin (PRF) but its use in arginine hydrochloride–induced necrosis has not been reported. This study presents a pediatric case treated with PRF. A 6.6-year-old girl with short stature underwent a growth hormone stimulation test. During peripheral intravenous infusion of arginine hydrochloride (9.1 g diluted in 10% sterile water at 180 mL/h), extravasation was detected 30 minutes after initiation. Initial management included prompt discontinuation of the infusion, limb elevation, and local dressing care; however, necrotic bullae developed. Despite debridement, topical sulfonated polyglycosaminoglycan, and red-light therapy, a deep ulcer formed on the dorsum of the left hand, extending to the muscle layer. On day 24, surgical debridement with preservation of tendon structures and autologous dermal grafting harvested from the scalp was performed. On day 32, allogeneic PRF prepared from 20 mL of maternal blood and supplemented with acidic fibroblast growth factor was applied to the exposed tendons. Postoperatively, the patient underwent regular outpatient follow-up with wound assessment, scar management, and hand function rehabilitation. At the 129-day follow-up, the wound had healed with a mildly raised scar, hand function was preserved, and the cosmetic outcome was satisfactory. Extravasation of arginine hydrochloride may cause severe skin necrosis in children; early recognition and multidisciplinary management, including surgery and PRF therapy, can improve healing and functional and cosmetic outcomes.