Subcutaneous fat necrosis of the infant

Abstract

Subcutaneous fat necrosis of the newborn and infant is a rare disease, with still unknown incidence, which usually occurs in term or post-term newborns that have experienced perinatal stress. It usually occurs within the fi rst six weeks of newborn's life; however, onset of the disease may be delayed for several months. A 6-week-old female infant was admitted to our department due to failure to thrive, irritability and vomiting. Physical examination in the area of the inner thighs, hips, back and shoulders, revealed the presence of subcutaneous infi ltrations, which were fi rm, slightly livid, and did not seem painful to touch. Laboratory analysis showed hypercalcemia, ultrasonographic review of body fat revealed hyperechogenicity, while abdominal ultrasound revealed nephrocalcinosis. Computerized tomography detected the presence of calcifi cations in the brain. Deep skin biopsy confi rmed the diagnosis of subcutaneous fat necrosis. Treatment included fl uid loading, termination of vitamin D substitution, and low calcium diet. Single doses of calcitonin and pamidronate were administered. After this therapy, calcium levels returned to normal range. Subcutaneous infi ltrates gradually decreased and became softer. In most reported cases, regression of skin lesions is expected after a few months, often without any residue on the skin. Elevated serum calcium may persist long after the withdrawal of cutaneous lesions, which is the reason for continuous monitoring of serum calcium and appropriate treatment in case of hypercalcemia in order to prevent metastatic calcifi cation.