Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2021; 9(29): 8804-8811
Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8804
Is mannitol combined with furosemide a new treatment for refractory lymphedema? A case report
Hyeon Seong Kim, Jae Young Lee, Ji Won Jung, Kyu Hoon Lee, Mi Jung Kim, Si-Bog Park
Hyeon Seong Kim, Jae Young Lee, Ji Won Jung, Kyu Hoon Lee, Mi Jung Kim, Si-Bog Park, Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
Author contributions: Kim HS was the patient’s physiatrist, reviewed the literature and contributed to manuscript drafting; Lee JY, Jung JW, Lee KH, and Kim MJ reviewed the literature and contributed to manuscript drafting; Park SB was responsible for manuscript revision for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Due to the patient’s stuporous mental status, informed consent was obtained from the patient’s son for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Si-Bog Park, MD, PhD, Professor, Department of Rehabilitation Medicine, Hanyang University Hospital, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea. sibopark@hanyang.ac.kr
Received: December 19, 2020
Peer-review started: December 19, 2020
First decision: July 18, 2021
Revised: July 30, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 16, 2021
Processing time: 300 Days and 3.8 Hours
Abstract
BACKGROUND

Mannitol is a hyperosmolar agent and the combination of mannitol and furosemide is a widely used treatment for intracranial pressure control. Considering the hypertonic properties of mannitol to move water out of intracellular spaces, we hypothesized that mannitol combined with furosemide could relieve focal tissue swelling in refractory lymphedema.

CASE SUMMARY

A 90-year-old female had been diagnosed with intracranial hemorrhage and received a combination of mannitol and furosemide for intracranial pressure control. Independent of the intracranial hemorrhage, she had refractory lymphedema of the left lower extremity since 1998. Remarkably, after receiving the mannitol and furosemide, the patient’s lower extremity lymphedema improved dramatically. After the mannitol and furosemide were discontinued, the lymphedema worsened in spite of complete decongestive therapy (CDT) and intermittent pneumatic compression treatment (IPC). To identify the presumed effect of mannitol and furosemide on the lymphedema, these agents were resumed, and the lymphedema improved again.

CONCLUSION

The present case raises the possibility that a combination of mannitol and furosemide might be considered another effective therapeutic option for refractory lymphedema when CDT and IPC are ineffective.

Keywords: Lymphedema; Mannitol; Furosemide; Rehabilitation; Intermittent pneumatic compression; Case report

Core Tip: Mannitol is a hyperosmolar agent and the combination of mannitol and furosemide is a widely used treatment for intracranial pressure control. We found dramatic improvement of refractory lymphedema after administration of mannitol and furosemide. After the mannitol and furosemide were discontinued, the lymphedema worsened in spite of complete decongestive therapy (CDT) and intermittent pneumatic compression (IPC). To identify the presumed effect of mannitol and furosemide on lymphedema, these agents were resumed, and the lymphedema improved again. The present case suggests that the combination of mannitol and furosemide could be considered as another effective therapeutic option for refractory lymphedema when CDT and IPC are ineffective.