Introduction: Subcutaneous fat necrosis (SFN) of the newborn is an inflammatory disorder of the adipose tissue that rarely disease which may be complicated with potentially life-threatening hypercalcemia. The etiology of hypercalcemia was related to persistently elevated 1,25-dihydroxyvitamin D3 levels.
Case: The case 47 days (length 0.3 SDS; weight −1.48 SDS) who presented sucking difficulty and debility duo to hypercalcemia with an initial physical examination determined indurated plaques over the back and buttocks without erythema. The baby girl at 38 weeks, weighing 4000 g were born by cesarean section. Newborn with complicated meconium aspiration syndrome had received treatment in new-born-service for 15 days. Laboratory and imaging tests revealed severe hypercalcemia (19.92 mg/dl), normal serum phosphorous (4.0 mg/dl), suppressed parathyroid hormone (3 pg/ml), hypercalciuria (2.37 urinary calcium (mg)/creatinine ratios (mg)), elevated 1,25-dihydroxyvitamin D3 levels (112 pg/ml) and nephrocalcinosis. Despite treatment with IV fluids, and furosemide, calcium levels remained high. The patient was given one doses (1 mg/kg per dose) of pamidronate. Calcium/creatinine ratios and calcium levels decreased within 72 h. Clinical symptoms resolved rapidly after normalization of serum calcium levels. A punch biopsy specimen showed multinucleated giant cells. No persistent nephrocalcinosis was observed. The usual treatment of hypercalcemia includes hyperhydratation, corticosteroids and diet. This treatment is not always effective in normalizing plasma calcium concentration. Recently, pamidronate has been used in the treatment of hypercalcemia associated with many disorders.
Conclusions: We report a 47-day-old baby who developed subcutaneous fat necrosis presented with symptomatic hypercalcemia which successfully treated with pamidronate infusion therapy. Pamidronate is effective, well-tolerated in the short-term.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology