Tumor lysis syndrome after propranolol therapy in ulcerative infantile hemangioma: rare complication or incidental finding?

Dermatology. 2012;224(2):106-9. doi: 10.1159/000337553. Epub 2012 Apr 19.


A 33-day-old female with an ulcerated infantile hemangioma (IH) undergoing oral therapy with propranolol 2 mg/kg per day developed hyperkalemia and hyperphosphatemia 24 h after starting medication. No electrocardiographic or clinical abnormalities secondary to the electrolyte changes were noticed. A laboratory tumor lysis syndrome (TLS) was diagnosed after excluding other causes of electrolyte imbalance in the diagnostic workup. No treatment was required to reverse the TLS condition, and the propranolol therapy was continued as the electrolyte alterations were only mild. One month later, the IH was remarkably reduced in size and no longer ulcerated. Maintenance of propranolol was extended for a total of 6 months. Parallel to the gradual involution of the IH, serum potassium and phosphorus levels returned within normal levels. We suggest that TLS may be a rare complication of ulcerated IH treated with propranolol. Clinicians must be aware and order appropriate screening tests for TLS in patients at risk.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Female
  • Hemangioma, Capillary / drug therapy*
  • Humans
  • Hyperkalemia / chemically induced
  • Hyperphosphatemia / chemically induced
  • Infant
  • Neoplastic Syndromes, Hereditary / drug therapy*
  • Propranolol / adverse effects*
  • Propranolol / therapeutic use
  • Severity of Illness Index
  • Skin Neoplasms / drug therapy*
  • Skin Ulcer / drug therapy*
  • Treatment Outcome
  • Tumor Lysis Syndrome / diagnosis
  • Tumor Lysis Syndrome / etiology*


  • Antineoplastic Agents
  • Propranolol

Supplementary concepts

  • Hemangioma, capillary infantile