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Subcutaneous Fat Necrosis of the Newborn

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1 Credit CME

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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Article Information

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 (beatriceda@sund.ku.dk).

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.

References
1.
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2.
Kannenberg  SMH , Jordaan  HF , Visser  WI , Ahmed  F , Bezuidenhout  AF .  Report of 2 novel presentations of subcutaneous fat necrosis of the newborn.   Dermatopathology (Basel). 2019;6(2):147-152.PubMedGoogle ScholarCrossref
3.
Bonnemains  L , Rouleau  S , Sing  G , Bouderlique  C , Coutant  R .  Severe neonatal hypercalcemia caused by subcutaneous fat necrosis without any apparent cutaneous lesion.   Eur J Pediatr. 2008;167(12):1459-1461."https://doi.org/10.1007/s00431-008-0682-5" PubMedGoogle Scholar
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Stefanko  NS , Drolet  BA .  Subcutaneous fat necrosis of the newborn and associated hypercalcemia: a systematic review of the literature.   Pediatr Dermatol. 2019;36(1):24-30.PubMedGoogle ScholarCrossref
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