Subcutaneous palivizumab (Synagis®) administration in an infant with congenital type 2B von Willebrand disease

Intramuscular injections are contra-indicated in infants with either acquired or congenital bleeding disorders. In such patients, it is unlicensed practice to administer vaccines by subcutaneous route. However, there are no reports on subcutaneous administration of palivizumab (Synagis®). We report on the tolerance and effects of subcutaneous palivizumab administration in a former preterm girl with type 2B von Willebrand disease. Repeated subcutaneous injections of palivizumab were well tolerated with minor local reactions and no systemic side effects. Consequently, we suggest to consider the subcutaneous instead of the intramuscular route in a setting of a valid indication for palivizumab, but a contraindication for intramuscular administration. More importantly, off-label or unlicensed practices should be reported to share and improve pharmacotherapy or at least illustrate knowledge gaps.