# A Multimodal Approach to a Complex PHACES Patient With Progressive Infantile Hemangioma: A Case Report and Review of Literature

## TL;DR

A baby with a severe PHACES syndrome and progressive hemangioma was successfully treated using a combination of therapies and multidisciplinary care.

## Contribution

This case report presents a unique, multimodal treatment approach for a complex PHACES patient with extensive disease.

## Key findings

- A multimodal treatment approach was effective in managing a complex PHACES patient with progressive hemangioma.
- Phased multidisciplinary care and compliance were critical to the successful outcome.
- Alternative treatments to propranolol monotherapy can be effective in resistant or non-compliant PHACES cases.

## Abstract

A three-week-old baby presented with an infantile hemangioma in segmental beard distribution and evidence of PHACES syndrome (posterior fossa abnormalities, hemangiomas, arterial anomalies, cardiac abnormalities, eye anomalies, and sternal defects). Due to the progressive and symptomatic growth of infantile hemangioma, this patient required a multimodal treatment approach, including beta-blocker therapy, intralesional steroid injections, periorbital surgical debulking, airway interventions, and embolization. This report highlights a successful case of a complex PHACES patient that illustrates the significance of phased multidisciplinary care and emphasizes the importance of compliance. A literature review is included to highlight previously reported successful cases using alternative treatments to propranolol monotherapy. This case offers a unique insight into the timeline and outcomes of a PHACES patient with extensive disease requiring a multimodal approach and highlights possible disease presentation in the non-compliant or resistant patient.