Diagnostic Dilemma

Subcutaneous Fat Necrosis

A 1½ month old girl born of non consanguineous marriage presented with fever for 5 days, thickening of skin over back, arms since 15 days of life. She was a post term caesarean section with meconium aspiration and required ventilatory support postnatally and required NICU stay for 15 days. She is immunized till OPV & BCG and is on exclusive breast feeds. On examination, the child was irritable, weight of 4-25 kg with subcutaneous fat necrosis over back, arms and thighs and crepitations in right lower zone. Other systems are normal.

What additional problem is expected?
Expert Opinion :
This child has subcutaneous fat necrosis which may be due to birth asphyxia (she was meconium aspiration and required ventilatory support). Subcutaneous fat necrosis can lead to hypercalcemia due to excessive production of 1, 25 dihydroxy Vitamin D in the necrosed fat. Hence this child should be screened for hypercalcemia. This child’s serum calcium was elevated (12.4 mg%) and ionic calcium was 2.28 mmol/L). This hypercalcemia may be life threatening and can lead to cardiac asystole. Another problem can be ectopic deposition of calcium in the body especially the kidneys. Thus the child should also be screened for nephrocalcinosis and renal dysfunction. The USG kidneys did show nephrocalcinosis and the child had hypercalciuria. Renal function tests were normal. The child now needs to be treated for hypercalcemia.
Answer Discussion :
Sangeetha Swaminathan
Subcutaneous fat necrosis
Sclerema neonatorum with sepsis to be ruled out

5 years ago
abbas Almamri
5 years ago

View More Comments

Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0