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Kellar A, Tangtatco JA, Weinstein M, Saunders N. Subcutaneous Fat Necrosis of the Newborn With Initial Hypocalcemia and Familial Recurrence: A Case Report. J Cutan Med Surg 2017; 22:223-225. [DOI: 10.1177/1203475417733459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subcutaneous fat necrosis of the newborn (SFNN) is a rare disorder characterised by indurated plaques or nodules with or without erythema, typically distributed over the cheeks, extremities, posterior trunk, buttocks, and thighs, and appears during the first 2 weeks of life. It is commonly associated with perinatal asphyxia and, while usually self-limited, can lead to severe hypercalcemia. There is no known familial association. The present article describes a neonate with extensive disease, counterintuitive hypocalcemia, and a family history of SFNN and reviews the existing literature on SFNN.
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Affiliation(s)
- Amelia Kellar
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Aileen Tangtatco
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam Weinstein
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Saunders
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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2
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Kim H, Bo-Abbas Y, Guenther LC. Cold-Induced Skin Disorders. J Cutan Med Surg 2016. [DOI: 10.1177/120347549600100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Humans are commonly exposed to extremes in temperature. Fortunately, our skin behaves as an anatomic and physiologic barrier during these periods. Exposure to cold temperatures may result in a variety of symptoms and disorders. Objective: Our current understanding of the pathophysiology, clinical presentation, and therapies of cold-induced skin disorders are reviewed. Methods: Studies, reviews, and book chapters that contained information on cold-induced skin disorders were reviewed. Conclusion: Cold-induced skin disorders are a heterogeneous group of disorders that cause great morbidity, particularly in cold climates. These entities can be classified as physiologic or pathologic responses to freezing or nonfreezing cold exposure.
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Affiliation(s)
- H.L. Kim
- Division of Dermatology, University of Western Ontario, London, Ontario
| | - Y. Bo-Abbas
- Division of Dermatology, University of Western Ontario, London, Ontario
| | - Lyn C. Guenther
- Division of Dermatology, University of Western Ontario, London, Ontario
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3
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Ricardo-Gonzalez RR, Lin JR, Mathes EF, McCalmont TH, Pincus LB. Neutrophil-rich subcutaneous fat necrosis of the newborn: A potential mimic of infection. J Am Acad Dermatol 2016; 75:177-185.e17. [PMID: 27157147 DOI: 10.1016/j.jaad.2016.02.1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/14/2016] [Accepted: 02/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The inflammatory infiltrate seen in biopsy specimens obtained from patients with subcutaneous fat necrosis of the newborn (SCFN) has classically been described as consisting mostly of histiocytes. However, we encountered patients with SCFN whose biopsy specimens revealed mostly neutrophils, prompting infection to be an initial consideration. OBJECTIVES We sought to describe cases of SCFN in which neutrophils formed the majority of the infiltrate at our institution and in the literature. METHODS We performed a retrospective analysis of patients with SCFN reported at our institution and a literature review of SCFN. RESULTS Thirteen cases of SCFN were identified at our institution. In 2 of 13 cases, neutrophils composed >75% of the inflammatory infiltrate, and both lesions were 1 day old. From the literature review, neutrophils were mentioned as a component of the infiltrate in 10 of 124 cases, but in none were neutrophils described as forming the majority of the infiltrate. LIMITATIONS This study is limited by its retrospective nature and small sample size. CONCLUSIONS Neutrophils can comprise most of the inflammatory cells in patients with SCFN, especially early in the course of the disease. This variant of SCFN can be easily mistaken for infection.
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Affiliation(s)
| | - James R Lin
- Department of Medicine, Kaiser Permanente Medical Center, Santa Clara, California
| | - Erin F Mathes
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Laura B Pincus
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California.
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Akcay A, Akar M, Oncel MY, Kızılelma A, Erdeve O, Oguz SS, Uras N, Dılmen U. Hypercalcemia due to subcutaneous fat necrosis in a newborn after total body cooling. Pediatr Dermatol 2013; 30:120-3. [PMID: 22352980 DOI: 10.1111/j.1525-1470.2011.01716.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subcutaneous fat necrosis is an inflammatory disorder of adipose tissue. Although patients need long-term follow-up to prevent hypercalcemia, the prognosis is generally favorable. We herein present a case of a newborn who developed subcutaneous fat necrosis-related hypercalcemia after hypothermia treatment for hypoxic ischemic encephalopathy. Widespread use of hypothermia treatment for hypoxic ischemic encephalopathy in the neonatal intensive care unit may increase the risk of developing subcutaneous fat necrosis and subsequently hypercalcemia. Great care should be taken to recognize skin findings early in newborns receiving hypothermia treatment, and those diagnosed with subcutaneous fat necrosis require close follow-up because they are at risk for developing hypercalcemia.
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Affiliation(s)
- Ahmet Akcay
- Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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5
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Hogeling M, Meddles K, Berk DR, Bruckner AL, Shimotake TK, Cohen RS, Frieden IJ. Extensive subcutaneous fat necrosis of the newborn associated with therapeutic hypothermia. Pediatr Dermatol 2012; 29:59-63. [PMID: 21906137 DOI: 10.1111/j.1525-1470.2011.01374.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subcutaneous fat necrosis of the newborn is a form of panniculitis that most often occurs in full-term infants with predisposing risk factors. Three neonates with hypoxic ischemic encephalopathy were treated with therapeutic hypothermia and developed extensive subcutaneous fat necrosis. All three infants developed extensive subcutaneous fat necrosis, involving the back, scalp, and arms. Mild, asymptomatic hypercalcemia was noted in one infant in the weeks following the subcutaneous fat necrosis. Hypothermia as a risk factor for subcutaneous fat necrosis is reviewed. Clinicians should be aware of subcutaneous fat necrosis as a possible risk factor and complication associated with asphyxiated newborns who may undergo therapeutic hypothermia. Future studies for therapeutic hypothermia should evaluate neonates for the development of subcutaneous fat necrosis.
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Affiliation(s)
- Marcia Hogeling
- Department of Dermatology, University of California, San Francisco, California, USA.
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6
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Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn-an unusual case and review of literature. Eur J Pediatr 2011; 170:1107-10. [PMID: 21318229 DOI: 10.1007/s00431-011-1405-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/18/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon, self-limiting panniculitis mostly occurring within the first few weeks after birth. SCFN has been described mostly in term or post-term newborn infants in literature. We report a preterm infant developing extensive subcutaneous fat necrosis within the first week of life after significant perinatal hypoxic injury. The infant was conservatively managed for subcutaneous fat necrosis but developed hypercalcaemia and required prolonged medical treatment. Hypercalcaemia is a rare but serious complication of subcutaneous fat necrosis and needs prolonged follow-up. The etiopathogenesis of both subcutaneous fat necrosis in newborn and the resultant hypercalcaemia are poorly understood. CONCLUSION Significant subcutaneous fat necrosis can develop in both preterm and term infants, and preterm infants also develop significant complications including hypercalcaemia.
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Affiliation(s)
- Subhabrata Mitra
- Clinical Research Fellow in Neonatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK.
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Kaptanoglu AF, Solaroglu A, Okutan E, Kilinc K. Effect of intrauterine ischaemia-reperfusion injury on rat skin. Clin Exp Dermatol 2009; 35:186-9. [PMID: 19663857 DOI: 10.1111/j.1365-2230.2009.03441.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It was previously demonstrated that decreased maternal blood flow might create impairment in skin development. The aim of this study was to show by means of lipid peroxidation the effect of intrauterine ischaemia-reperfusion injury on fetal rat skin. METHODS In total, 24 female Spraque-Dawley rats, 19 days pregnant, were used. They were separated into three groups (n = 8): a control group, a sham-operated group and an experimental group. Laparotomy was performed on all three groups. In the sham-operated and experimental groups, utero-ovarian artery dissection was performed in addition. In the experimental group, fetal ischaemia was induced by clamping the utero-ovarian artery bilaterally for 30 min, and reperfusion was achieved by removing the clamps for 60 min. At the end of the experiment, the fetuses were removed by caesarean section and skin specimens were taken from the fetuses. Lipid peroxidation in the skin tissues was determined as thiobarbituric acid reactive substance (TBARS) concentration for each fetal rat. One-way ANOVA and post hoc tests were used for statistical analysis. RESULTS The level of TBARS was significantly increased in the fetal rat skin after ischaemia-reperfusion injury compared with the control group. CONCLUSION Lipid peroxidation has an important role in intrauterine ischaemia-reperfusion-induced fetal skin damage in rats.
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Affiliation(s)
- A F Kaptanoglu
- Department of Dermatology, Bayindir Hospital Ankara, Ankara, Turkey.
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8
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Lim JW, Kim YJ. Subcutaneous Fat Necrosis of the Lower Eyelid Associated with Anemia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.3.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Won Lim
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Gyeonggi, Korea
| | - Yun Jeong Kim
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Gyeonggi, Korea
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9
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Affiliation(s)
- E Mahé
- Service de Dermatologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt.
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10
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Mahé E, Girszyn N, Hadj-Rabia S, Bodemer C, Hamel-Teillac D, De Prost Y. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children. Br J Dermatol 2007; 156:709-15. [PMID: 17493069 DOI: 10.1111/j.1365-2133.2007.07782.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subcutaneous fat necrosis (SFN) of the newborn is a rare acute transient hypodermatitis that develops within the first weeks of life in term infants. It often follows a difficult delivery. Prognosis is generally good except for the development of hypercalcaemia in severe cases. Only several case reports or small patients series have been published. OBJECTIVES To evaluate risk factors, complications and outcomes of SFN in 16 consecutive patients seen from 1996 to 2002 in our Department of Paediatric Dermatology. METHODS On a case-report form created for the study, we recorded putative risk factors concerning the mother, pregnancy and delivery, clinical aspects of SFN, and early and late outcomes. The study was conducted in two stages: the first was a retrospective analysis of the observations and the second analysed data collected on children and their parents during a new consultation (n=10). RESULTS All the children were born at term. Lesions appeared a mean of 4 days after delivery. Three-quarters of the children had diffuse SFN. Risk factors identified were newborn failure to thrive (12/16), forceps delivery (7/16), maternal high blood pressure (3/10) and/or diabetes (2/10), and newborn cardiac surgery (1/16). Putative novel risk factors were macrosomia (7/16), exposure to active (4/10) or passive (3/10) smoking during pregnancy, putative or known maternal, paternal or newborn risk factors for thrombosis (5/10), and dyslipidaemia (2/10). Complications were hypercalcaemia (9/16), pain (4/16), dyslipidaemia (1/16), renal insufficiency (1/16) and late subcutaneous atrophy (6/6). CONCLUSIONS This study on 16 newborns with SFN provides new information. Familial or newborn risk factors for thrombosis are frequent. Macrosomia, familial dyslipidaemia and smoking should be evaluated. The main complications identified were severe pain, hypercalcaemia and subcutaneous atrophy.
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Affiliation(s)
- E Mahé
- Department of Dermatology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Borgia F, De Pasquale L, Cacace C, Meo P, Guarneri C, Cannavo SP. Subcutaneous fat necrosis of the newborn: be aware of hypercalcaemia. J Paediatr Child Health 2006; 42:316-8. [PMID: 16712567 DOI: 10.1111/j.1440-1754.2006.00862.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Subcutaneous fat necrosis of the newborn is an uncommon, self-limiting panniculitis that usually occurs in full-term infants as a consequence of perinatal asphyxia. The cutaneous involvement may be associated with metabolic complications such as hypoglycaemia, thrombocytopenia, hypertriglyceridemia, anemia and hypercalcaemia. The delayed onset of hypercalcaemia, 1-6 months after the development of the skin manifestations, imposes a prolonged follow-up to avoid its acute toxic effects on cardiovascular and renal systems and the more durable metastatic calcifications.
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Affiliation(s)
- Francesco Borgia
- Institute of Dermatology, University Hospital G. Martino, Messina, Italy.
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12
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Tran JT, Sheth AP. Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature. Pediatr Dermatol 2003; 20:257-61. [PMID: 12787278 DOI: 10.1046/j.1525-1470.2003.20315.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Subcutaneous fat necrosis of the newborn is an uncommon, self-limited panniculitis of neonates. Rare complications such as hypercalcemia, thrombocytopenia, hypertriglyceridemia, and hypoglycemia have been reported. We describe the first case where all of the above complications were encountered in the same infant. Physicians caring for infants with subcutaneous fat necrosis of the newborn should be aware of the above associations in order to provide prompt and appropriate treatment to prevent associated, undesirable sequelae.
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Affiliation(s)
- Julie Thao Tran
- Department of Dermatology, Children's Hospital Medical Center of Cincinnati, University of Cincinnati, Cincinnati, Ohio, USA
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13
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Abstract
UNLABELLED The second part of our review of panniculitis summarizes the clinicopathologic features of the mostly lobular panniculitides. Erythema induratum of Bazin (nodular vasculitis) represents the most common variant of lobular panniculitis with vasculitis, although controversy persists about the nature of the involved vessels. Mostly lobular panniculitides without vasculitis comprise a series of disparate disorders. These include sclerosing panniculitis that results from chronic venous insufficiency of the lower extremities; panniculitis with calcification of the vessel walls such as calciphylaxis and oxalosis; and inflammatory diseases with crystals within the adipocytes such as sclerema neonatorum, subcutaneous fat necrosis of the newborn, and poststeroid panniculitis. Connective tissue diseases, such as systemic lupus erythematosus and dermatomyositis, pancreatic diseases, and alpha(1)-antitrypsin deficiency may also show a mostly lobular panniculitis with characteristic histopathologic features. Lobular panniculitis may also be an expression of infections, trauma, or factitial causes involving the subcutaneous fat. Lipoatrophy refers to a loss of subcutaneous fat due to a previous inflammatory process involving the subcutis, and it may be the late-stage lesion of several types of panniculitis. In contrast, lipodystrophy means an absence of subcutaneous fat with no evidence of inflammation and often the process is associated with endocrinologic, metabolic, or autoimmune diseases. Finally, cytophagic histiocytic panniculitis is the term that has been used to describe two different processes: one is inflammatory, a lobular panniculitis, and the other one is neoplastic, a subcutaneous T-cell lymphoma. The only common feature of these two different processes is the presence of cytophagocytosis in the lesions. (J Am Acad Dermatol 2001;45:325-61.) LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with the pathogenesis, clinical manifestations, histopathologic findings, and treatment options for the most frequent variants of the lobular panniculitides.
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Affiliation(s)
- L Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Abstract
Subcutaneous fat necrosis (SFN) of the newborn characteristically affects full-term infants who have experienced perinatal distress, such as hypothermia, obstetric trauma, or asphyxia. We report a newborn who had pallor, deep breathing, and severe anemia immediately after birth. She developed SFN on the fourth postnatal day. Her condition improved after blood transfusions and the skin lesions resolved in 6 weeks. This appears to be the first report of SFN associated with anemia.
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Affiliation(s)
- B Varan
- Department of Pediatrics, Başkent University School of Medicine, Ankara, Turkey
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15
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Abstract
Subcutaneous fat necrosis (SFN) of the newborn is uncommon and usually occurs in the first weeks of life following a complicated delivery. The frequency with which hypercalcemia develops as a complication is uncertain. We report the clinical features of SFN in 11 patients seen between 1991 and 1998. Ten were born by cesarean section and fetal distress was present in the majority. It was not possible to distinguish SFN from sclerema neonatorum by time of onset or related infant diseases. Hypercalcemia developed in four infants up to 7 weeks after the onset of SFN. Infants with this condition should be carefully monitored for hypercalcemia.
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Affiliation(s)
- A D Burden
- Department of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
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Repiso-Jiménez J, Márquez J, Sotillo I, García-Bravo B, Camacho F. Subcutaneous fat necrosis of the newborn. J Eur Acad Dermatol Venereol 1999. [DOI: 10.1111/j.1468-3083.1999.tb01040.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We present two patients with subcutaneous fat necroses (SCFN) in whom endocrinologic studies revealed an association with elevated prostaglandin E (PGE) levels. A boy born after prolonged labor complicated by meconium aspiration developed erythematous, indurated plaques over the back, arms, buttocks, and cheeks at 4 days of age. A biopsy specimen of involved skin showed panniculitis with foci of necrotic adipocytes containing radially arranged, needle-shaped clefts and a granulomatous infiltrate in the septae. Laboratory studies revealed hypercalcemia of 13.6 mg/dl (normal 8.8-10.1 mg/dl), elevated 1.25-1.25(OH)2D3, and increased urinary excretion of PGE2. The child was hospitalized and treated with systemic steroids and diuretics, with resolution of SCFN and hypercalcemia. The second patient was a girl born with cyanotic heart disease. A diagnosis of Ebstein anomaly was made, and intravenous PGE1 was started to keep patent the ductus arteriosus. Four days later erythematous, indurated plaques were noted on the knee, back, and anterior chest. A skin biopsy specimen revealed SCFN. There was no associated laboratory abnormality. On discontinuing PGE1, no new lesions formed and the existing panniculitis resolved. These two cases demonstrate the association between SCFN and elevated PGE levels (endogenous in patient 1, exogenous in patient 2). No previous reports of SCFN after the administration of PGE1 have appeared in the literature.
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Affiliation(s)
- H Sharata
- Department of Medicine, University of Wisconsin-Madison 53705, USA
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