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A full-term male infant was delivered by emergency cesarean delivery owing to fetal distress. At delivery, the neonate had no spontaneous respiration or heartbeat and was cyanotic and floppy. The infant was resuscitated and gradually stabilized. Umbilical cord blood gas analysis showed severe metabolic acidosis.
Over the next couple of days, his C-reactive protein level increased (>20 mg/dL; to convert to mg/L, multiply by 10), and a broad infection screening was performed, including blood cultures, lumbar puncture, urine analysis, chest radiography, and abdominal ultrasonography. Empirical broad spectrum antibiotic and antiviral treatment was administered. No focus of infection was identified. From the tenth day, blood calcium levels were persistently elevated. On the sixteenth day of life, the neonate developed painful and slightly erythematous subcutaneous nodules on the upper back and posterior arms (Figure, A). Punch biopsy results revealed predominantly lobular panniculitis with rich infiltration of lymphocytes and macrophages. In addition, a mild granulomatous response was noted with scattered multinucleate giant cells (Figure, B), which was consistent with subcutaneous fat necrosis (SCFN) of the newborn.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Beatrice Dyring-Andersen, MD, PhD, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark (firstname.lastname@example.org).
Published Online: May 4, 2022. doi:10.1001/jamadermatol.2022.1240
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s parents for granting permission to publish this information.
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