Background: Subcutaneous fat necrosis (SCFN) of the newborn is a rare condition that manifests within days after birth. The interscapular region, axillae and shoulders are the most commonly affected sites, corresponding to anatomic sites of brown adipose tissue (BAT) in newborns. Objective: We postulated a specific involvement of BAT in SCFN and searched for brown adipocytes at affected sites. Methods: Biopsy specimens were immunostained with antibodies against uncoupling protein 1 (UCP-1) and examined by electron microscopy. We also examined BAT by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET-CT) scanning. Results: A few cells in biopsy specimens from two patients bound antibodies against UCP-1, and brown adipocytes were detected at several stages of degeneration. PET-CT scans revealed lower uptake of 18F-FDG at major sites of SCFN. Conclusion: SCFN and BAT can be found at the same sites, suggesting a pathophysiological connection.
The patient was a 74-year-old woman with Parkinson's disease who had a past history of total hysterectomy for uterine myoma. She was admitted for a femoral neck fracture and treated conservatively. From the third day of the illness, the patient experienced increased urinary frequency and constant urge to urinate. On the seventh day, the patient developed peritonitis and underwent emergency surgery. Laparotomy confirmed a dark greenish malodorous abscess in the abdominal cavity. The bladder was necrotic and perforated, and the patient was accordingly diagnosed with panperitonitis caused by bladder gangrene. Because almost the entire bladder exhibited full-layer necrosis, it was determined that bladder preservation would not be possible, and total cystectomy, bilateral ureterocutaneostomy, and abdominal drainage were performed. Postoperatively, residual intra-abdominal abscess was present, but this resolved with drainage and antibiotic administration. Here, we present this patient who survived extremely rare pan-peritonitis caused by bladder gangrene.
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