Refractory Ulcerated Infantile Hemangioma Successfully Treated With Bleomycin Sclerotherapy: A Case Report

BACKGROUND Infantile hemangiomas (IH) are the most common benign vascular tumors in infants. While most of these lesions undergo spontaneous involution or respond favorably to propranolol, some cases present with early ulceration, aggressive progression, or resistance to standard therapy. Managing such complex cases remains challenging and requires individualized, multidisciplinary strategies and timely escalation to alternative modalities. Here, we report a medically refractory case of ulcerated infantile hemangioma and highlight the role of bleomycin sclerotherapy as a rescue therapy option. CASE REPORT We report the case of a 6-month-old female with multiple cutaneous and hepatic infantile hemangiomas, including a facial lesion with extensive ulceration involving the nasal and upper-lip regions. Histopathologic examination with positive GLUT-1 immunostaining confirmed the diagnosis of infantile hemangioma. Despite treatment with propranolol and adjunctive systemic corticosteroids, the ulceration worsened. Sirolimus was initiated but clinical deterioration continued within days, leading to the decision to provide interventional management. A single session of fluoroscopy-guided percutaneous bleomycin sclerotherapy was performed, resulting in rapid ulcer healing and sustained lesion stability. No adverse events occurred during or after the procedure. CONCLUSIONS Bleomycin sclerotherapy may be an effective and safe therapeutic option for propranolol resistance ulcerated infantile hemangiomas that fail conventional medical therapy. Early multidisciplinary evaluation and timely escalation to interventional treatment may help prevent progressive tissue destruction and improve functional and cosmetic outcomes in selected refractory cases.