Introduction: Subcutaneous fat necrosis (SCFN) is an uncommon inflammatory disorder of the adipose tissue. Though hypercalcaemia secondary to SCFN is a well-recognised entity, reported cases with persistence of symptoms requiring prolonged treatment as in our case are rare. There are also limited reports about the severity and duration of hypercalcaemia secondary to SCFN with possible correlation of the severity to the extensity of the skin lesions. We present a neonate who developed severe hypercalcaemia secondary to subcutaneous fat necrosis at 2 weeks of age which proved difficult to manage until 7 months of age.
Case report: The term baby (4.3 kg) had significant hypoxia (pH 6.8) at birth requiring intensive care treatment. On day 10 she was noted to have firm palpable subcutaneous erythematous plaques all over her back suggestive of SCFN. Her bloods revealed hypercalcaemia (~3.05 mmol/l) requiring fluids, diuretics, and low calcium milk. The investigations for other causes of hypercalcaemia were inconclusive. She was treated with prednisolone (2 mg/kg per day) due to persistent hypercalcaemia (~3.53 mmol/l) with good effect. Attempts to wean her from prednisolone resulted in recurrence of hypercalcaemia. The reason for differing the use of bisphosphonates in this case was the exquisite steroid sensitivity which our patient demonstrated. She required close monitoring of her calcium levels, renal ultrasound scans, and parent education to return for early assessment if she was symptomatic. Eventually at 7 months she weaned from the prednisolone and low calcium feed (latest ~2.83 mmol/l). She is currently thriving with normal development. The skin lesions have almost resolved now at 7 months of age.
Conclusion: Hypercalcaemia though rare, is a serious complication of subcutaneous fat necrosis which can be fatal if not treated appropriately. Prolonged follow up with diligent management is essential.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology