Subcutaneous Fat Necrosis of the Newborn: A Case Report of a Term Infant Presenting with Malaise and Fever at Age of 9 Weeks

Subcutaneous fat necrosis in an infant with hypoxic ischaemic encephalopathy stage 3: an uncommon association

Subcutaneous fat necrosis (SCFN) is inflammation and necrosis of adipose tissue associated with hypoxia and hypothermia. It leads to various metabolic abnormalities, of which the most dreaded is hypercalcaemia. We report a case of a 7-week-old boy with history of birth asphyxia (hypoxic ischaemic encephalopathy stage 3) who presented to us with features suggestive of hypercalcaemia with bilateral nephrocalcinosis. On examination, there were multiple subcutaneous nodules on both arms. Evaluation revealed suppressed parathyroid activity along with low levels of 25(OH)vitamin D₃ and elevated 1,25-dihydroxyvitamin D₃ Skin biopsy confirmed the diagnosis of SCFN. He was managed with intravenous fluids, single dose of intravenous furosemide and oral prednisolone. Hypercalcaemia responded within 14 days of admission, prednisolone was tapered and stopped in a month. SCFN, in our case, can be attributed to the underlying perinatal asphyxia along with use of therapeutic hypothermia. Through this case, we wish to sensitise practicing neonatologists for the need of screening and early identification of these abnormalities, which if missed can be fatal.

Subcutaneous fat necrosis of the newborn and nephrolithiasis

Objectives

Subcutaneous fat necrosis of the newborn (SCFN) is a rare panniculitis that can affect newborn patients who have experienced perinatal stress, hypoxia, or hypothermia. Risk factors include gestational diabetes and pre-eclampsia. This condition is usually self-limiting; however, it can lead to severe complications, including hypercalcemia. After diagnosis, it is important to monitor calcium levels. There is no current standard for how frequently these levels should be monitored.

Case presentation

We present a full-term African American male with multiple risk factors, who was diagnosed with SCFN. The patient’s hypercalcemia secondary to SCFN led to renal complications.

Conclusions

This case highlights the importance of early and frequent monitoring of calcium levels in patients with SCFN.

Neonatal subcutaneous fat necrosis with hypercalcemia treatment using calcitonin

Subcutaneous fat necrosis of newborn is a form of noninfectious panniculitis. It is an uncommon condition and mostly occurs in full-term infants within first weeks of life that have had a significant condition such as hypoxic-ischemic encephalopathy at the time of birth. Subcutaneous fat necrosis of newborn is usually a self-limiting condition but may be associated with hypercalcemia, which may lead to life threatening levels. Hypercalcemia is a significant reason of subcutaneous fat necrosis and needs an intervention involving hyperhydration, calcitonin, diuretics, steroids and sometimes bisphosphonate in resistant cases. Here, we have reported the case of a term infant who developed extensive subcutaneous fat necrosis in the first week of life after significant perinatal hypoxic injury. Her condition was complicated by hypercalcemia resistant to prolonged medical treatment with hyperhydration, diuretic and steroid but eventually the infant responded to high doses of calcitonin.

Newborn With Enlarged Erythematous Mass on Back: Case Report and Review of Medical Literature

Newborn skin nodules are usually benign and self-resolving skin condition. Differential diagnosis of such lesions include cysts, hemangioma, abscess, cellulitis, sclerema neonatorum, subcutaneous fat necrosis, neurofibromatosis, benign tumors, or malignant tumors such as rhabdomyosarcoma, infantile fibrosarcoma, or neuroblastoma. We report a case of congenital subcutaneous fat necrosis in a 7-day-old baby presenting with multiple erythematous mass on back.