నైరూప్య

Extensive subcutaneous fat necrosis complicated by neonatal hypercalcaemia.

Waad M. Al-Ghamdi, Asmaa Adel Milyani, Abdulmoein Eid Al-Agha

Subcutaneous Fat Necrosis (SCFN) is a benign and often self-limiting inflammatory disorder experienced by newborns that were exposed to perinatal stress in either form of asphyxia, hypothermia, cord prolapse, and/or sepsis. Lesions are usually benign and completely resolve within a duration ranging between a few weeks up to 6 months. They can be accompanied by multiple systemic complications, of which the most significant and of life-threatening potential is neonatal hypercalcaemia. If not timely anticipated and adequately treated, the patient might deteriorate due to dehydration and acute renal failure. Symptoms of neonatal hypercalcaemia can be variable in this age group, transcending from a nonspecific presentation of irritability, poor feeding, vomiting and constipation to the well recognised polyuria, polydipsia, and dehydration. Therapeutic options are provided through initial hyperhydration and calcium wasting diuretics, switching feeds to a low calcium and vitamin D formula milk, institution of systemic steroids and if necessary, initiating bisphosphonate therapy in hypercalcaemia that is severe and recalcitrant to the previously mentioned treatment modalities, and/or when a rapid decrease in serum calcium levels is desired. In this report we describe a case of a 10 month old female infant with moderate neonatal hypercalcaemia as a complication of extensive SCFN manifesting by the age of 10 days and persisting into a pro-longed clinical course of 9 months until most of the lesions were resolved.