Iatrogenic calcinosis cutis in a neonate

Abstract

Calcification of soft tissues occur, secondary to trauma sustained in the course of neonatal intensive care. They can present with swelling and inflammatory signs, which mimic serious infections of bone, joints and soft tissues. The etiology of the presenting inflammatory response is often unknown and the clinical picture is variable. Hence babies get subjected to more invasive procedures and medications. Recognition is by awareness and radiography the key to diagnosis. Masterly inactivity and vigilance during followup is suggested.

Indurated, non‐tender nodules at peripheral IV sites in a newborn

“…Calcinosis cutis (CC) is an uncommon disorder characterized by hydroxyapatite crystals of calcium phosphate deposited in the dermis and subcutaneous tissue . CC is classified into five subtypes according to etiology: dystrophic, metastatic, iatrogenic, calciphylaxis, and idiopathic .…”

“…Calcinosis cutis (CC) is an uncommon disorder characterized by hydroxyapatite crystals of calcium phosphate deposited in the dermis and subcutaneous tissue . CC is classified into five subtypes according to etiology: dystrophic, metastatic, iatrogenic, calciphylaxis, and idiopathic . Iatrogenic calcinosis cutis is generally seen in infants who are subjected to multiple heel sticks, punctures for intravenous access in intensive care units, administration and extravasation of calcium‐ or phosphate‐containing infusions or medications …”

“…The cutaneous manifestations of iatrogenic CC present as single or multiple firm, tender erythematous papules, nodules, or plaques with surrounding swelling and in rare cases necrosis . Clinical manifestations and radiograph findings of soft tissue calcification generally appear around 2 weeks, but may range between 1 and 3 weeks …”

“…Calcinosis cutis can be mistaken for thrombophlebitis, early cellulitis, abscess, or hematoma, especially in the presence of inflammation around the site of venipuncture and a lack of radiographic findings early in the course of the disease . Diagnosis is made through history of extravasation following calcium infusion and radiologic findings of a characteristic amorphous calcific mass localized in the soft tissues .…”

“…If extravasation does occur and subsequently CC develops, treatment should remain conservative as the course of CC in neonates is benign . Conservative treatment includes immediate removal of the suspected catheter and application of ice packs for 15 minutes four times a day, along with elevation of the affected limbs .…”