Subcutaneous fat necrosis of the newborn and idiopathic hypercalcemia. Report of a case

Abstract

A female infant who was anoxic at birth had lesions of subcutaneous fat necrosis at the age of 16 days. She also had problems with poor feeding, frequent vomiting, and failure to thrive. Hypercalcemia was discovered at the age of 28 days and she died at 11 1/2 weeks despite return of the serum calcium level to normal with oral prednisone therapy and a diet low in calcium and devoid of vitamin D. Fourteen other cases of idiopathic hypercalcemia in patients with subcutaneous fat necrosis of the newborn have been reported. Most of these infants were full-term with prenatal complications. The hypercalcemia was usually diagnosed much later than the subcutaneous fat necrosis. Both conditions generally resolved without sequelae, but two of the 14 infants died. The causal relation between these two entities, if one exists, remains unknown. Infants with subcutaneous fat necrosis should have serial serum calcium determinations and should be observed closely for signs and symptoms of hypercalcemia, which include irritability, anorexia, constipation, and failure to thrive.

Congenital Ulcerated Subcutaneous Fat Necrosis of the Newborn

“…SFN, no longer considered a localized form of SN, is an uncommon neonatal disorder appearing in infants born at term or post-term, frequently by cesarean section and with a history of fetal distress [11, 12, 13]. The clinical manifestations usually appear between the 1st and 4th week of life [11, 12, 13, 14, 15].…”

“…The clinical manifestations usually appear between the 1st and 4th week of life [11, 12, 13, 14, 15]. To date, very few cases with lesions present at birth have been reported [16, 17, 18, 19, 20].…”

An Infant With Firm, Fixed Plaques

“…1,[5][6][7][8][9][10][11][12][13][14] Complications related to hypercalcemia may be severe and have been implicated in the deaths of 3 infants. [10][11][12] Explanations offered for hypercalcemia include elevated parathyroid hormone levels, prostaglandin E 2 release, direct release of calcium from necrotic fat, or increased vitamin D activity. [12][13][14] However, the latter explanation is most widely accepted, and was likely responsible for the hypercalcemia documented in our patient.…”

Subcutaneous Fat Necrosis of the Newborn and Idiopathic Hypercalcemia

“…It generally affects healthy full-term infants, often those who have suf fered perinatal difficulties [ 1 ]. 11 is sometimes seen in post term infants [2,3].…”

“…It has been suggested that hypercalcemia may be the result of the release of calcium from calcified necrotic subcutaneous fat [19], although it has been shown that diffuse soft tissue calcification can occur and resolve without evidence of hypercalcemia [20]. It has been proposed that hypercalcemia may be due to hyper sensitivity to vitamin D [21], or elevated parathyroid hor mone levels [1]. Autopsy studies, however, have not shown parathyroid hyperplasia [211.…”