Safe Endoscopic Treatment for a Bleeding Infant With Multifocal Lymphangioendotheliomatosis and Thrombocytopenia (MLT)

TL;DR

A 3-week-old infant with a rare condition causing severe bleeding was successfully treated using a minimally invasive endoscopic technique.

Contribution

This case highlights the effective use of argon plasma coagulation for managing life-threatening bleeding in infants with MLT.

Findings

Argon plasma coagulation successfully achieved hemostasis in an infant with MLT and active gastrointestinal bleeding.

APC may be a viable treatment option for refractory bleeding in MLT when surgical support is available.

Gastrointestinal perforation remains a potential risk with endoscopic therapy in MLT.

Abstract

We present the case of a 3-week-old girl with multiple cutaneous vascular lesions, melena, hematemesis, severe anemia (hemoglobin 4.4 g/dL), and thrombocytopenia (72 × 103/µL), with clinical features consistent with multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT). Upper gastrointestinal endoscopy revealed numerous actively bleeding angiomatous lesions, measuring 1–3 mm in diameter. Homeostasis was successfully achieved using argon plasma coagulation (APC). To our knowledge, this is among the few reports describing the effective use of APC in managing life-threatening gastric hemorrhage in an infant with MLT. While gastrointestinal perforation has been previously reported as a complication of endoscopic therapy in this context, our findings suggest that APC may be a viable option for refractory bleeding, provided that surgical support is immediately accessible.

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