Neonatal hypercalcemia associated with extensive subcutaneous fat necrosis: a case report

Subcutaneous fat necrosis (SCFN) of the newborn is rare self-limited fat tissue inflammation that usually occurs in term or post-term newborns exposed to perinatal stress factors, such as perinatal asphyxia, meconium aspiration, neonatal sepsis, and therapeutic hypothermia. SCFN usually appears in the first few weeks of life and has a benign course with spontaneous resolution. Monitoring for complications, in particular the potentially life-threatening hypercalcemia, is crucial. In this report, we describe a male infant with extensive SCFN and neonatal hypercalcemia that went through a prolonged course.

Pancreatic Panniculitis in Patients with Chronic Pancreatitis: Case Report and Review of Literature / 대한소화기학회지

Pancreatic panniculitis is a rare complication characterized by subcutaneous fat necrosis associated with pancreatic disease. It has been postulated that pancreatic panniculitis is caused by the systemic activity of pancreatic enzymes that lead to microcirculatory disturbances. We report a 41-year-old heavy alcoholic woman with pancreatic panniculitis that coexisted with acute and chronic pancreatitis. She was diagnosed with chronic pancreatitis and alcoholic liver cirrhosis 5 years ago. She presented with multiple, tender, erythematous, subcutaneous nodules with heat sensation on both lower legs. Laboratory evaluation revealed an increase in the serum blood amylase and lipase. Histopathologic findings showed fat necrosis with inflammation around the necrotic subcutaneous fat tissue. The lesions subsided gradually with an improvement of acute pancreatitis.

Necrosis grasa subcutánea con hipercalcemia persistente en un neonato tratado con hipotermia terapéutica: Reporte de un caso / Subcutaneous fat necrosis and persistent hypercalcaemia in a newborn treated with therapeutic neonatal hypothermia: A case report

La hipotermia terapéutica constituye el tratamiento de elección para los recién nacidos con encefalopatía hipóxico-isquémica moderada-grave, que cambia el pronóstico de estos niños y se acepta como una técnica segura y con escasas complicaciones secundarias considerando su beneficio. Un posible efecto adverso es la necrosis grasa subcutánea, una paniculitis transitoria aguda de presentación durante las primeras semanas de vida. Se presenta un caso de un recién nacido a término afecto de encefalopatía hipóxico-isquémica con lesiones cutáneas en forma de eritema multiforme generalizado y placas eritematosas firmes e induradas en la espalda, los glúteos y las extremidades a los 12 días de vida, tras el tratamiento con hipotermia. El estudio histopatológico, tras la biopsia cutánea, confirmó la sospecha de necrosis grasa subcutánea. Al mes de vida, presentó cifras elevadas de calcio sérico, que precisaron tratamiento con hidratación intravenosa y diuréticos. La calcemia descendió hasta normalizarse a los 3 meses, con desaparición progresiva de las lesiones cutáneas.

Therapeutic hypothermia is the current standard treatment in newborns with moderate to severe hypoxic-ischemic encephalopathy, changing the outcome of these children. It is considered a safe technique with almost no side effects. A possible adverse side event is subcutaneous fat necrosis, which is an acute self-limiting panniculitis that develops during the first weeks of life. We report a case of a newborn at term suffering hypoxic-ischemic encephalopathy with a generalized multiform erythematous rash and firm and indurated plaques over the back, buttocks and extremities on his 12th day of life after being treated with therapeutic hypothermia. Histopathological study after skin punchbiopsy confirmed the suspicion of subcutaneous fat necrosis. The infant developed asymptomatic moderate hypercalcaemia within the first month of life, which was treated with intravenous fluids and diuretics. Serum calcium levels decreased and normalized in 3 months, with progressive disappearance of skin lesions.

Subcutaneous fat necrosis in neonate:a case report and literature review / 临床儿科杂志

Objective To investigate diagnostic methods and treatment of subcutaneous fat necrosis in neonate (ScFN). Methods The clinical data of a case with ScFN was reported and the etiology, pathogenesis, and differential diagnosis were reviewed. Results The case was a 2 days female newborn delivered via cesarean section at full-term, and she came to hospital because of indurated nodules and plaques in the back and shoulders. Anti-infection treatment after admission was not effective. On the 10th day in hospital, the back lesions appear as soft and lfuctuant and then diagnosed as ScFN by biopsy which showed a small amount of inflammatory cell infiltration and fatty degeneration. The patient was followed up with good prognosis. Conclusions ScFN is a benign self-limiting fat disease, mostly occurred in the first four weeks of full-term newborns with history of abnormal childbirth.

Paniculitis pancreática recurrente asociada a pancreatitis biliar: reporte de un caso y revisión de la literatura / Recurrent pancreatic panniculitis associated to biliary pancreatisis: case report and review of the literature

La asociación entre enfermedades pancreáticas y necrosis de la grasa subcutánea se conoce desde 1883. En el casopresentado la paciente había sufrido de episodios recurrentes de dolor abdominal y aparición de nódulos en miembrosinferiores que fueron interpretados en consultas previas como entidades separadas. En nuestro servicio se lediagnosticó pancreatitis aguda biliar leve. A las 48 horas aparecieron nódulos cuya biopsia demostró necrosis e inflamaciónlobulillar sin vasculitis de la grasa subcutánea, con presencia de “células fantasma”, características histológicastípicas de la paniculitis pancreática. La evolución de la paciente fue favorable, desapareciendo los nódulos luegode la resolución de la pancreatitis, no volviendo a recurrir después de la colecistectomía. La paniculitis pancreáticaconsiste en una necrosis grasa, que se presenta con poca frecuencia en patologías del páncreas de distinta naturalezay es causada, probablemente, por la acción de enzimas liberadas al torrente sanguíneo, que alcanzan diferentes órganosdeterminando manifestaciones clínicas extraabdominales. Se manifiesta por nódulos dolorosos que se localizancon más frecuencia en miembros inferiores, y que pueden preceder a las manifestaciones abdominales. Su evoluciónes benigna y el tratamiento es el de la enfermedad de base

The association between pancreatic disease and subcutaneous fat necrosis is known since 1883. In the case presented here,the patient had suffered recurrent episodes of abdominal pain and nodules in the legs that were interpreted as separate entitiesin previous consultations. In our hospital she was diagnosed as having mild acute biliary pancreatitis. After 48 hourssome nodules appeared in the legs. Biopsy showed lobular necrosis and inflammation of subcutaneous fat without vasculitis;“ghost cells” were seen. These were typical histological features of pancreatic panniculitis. The patient had a satisfactoryevolution, the nodules disappeared after the resolution of pancreatitis, without recurrence after cholecystectomy. Pancreaticpanniculitis is a fat necrosis, which occurs infrequently in pancreatic diseases of different etiologies and is probably causedby the action of enzymes released into the bloodstream, causing different extraabdominal manifestations. It is characterizedby painful nodules that are located more frequently in the lower limbs, which may precede abdominal manifestations. Itsevolution is benign and treatment is that of the underlying disease

Pancreatic Panniculitis Associated with Acinar Cell Carcinoma of the Pancreas: A Case Report

Pancreatic panniculitis is a rare type of disorder associated with pancreatic diseases. We describe here a case of 54-year-old man who was admitted to the Department of Dermatology with the diagnosis of erythema nodosum. The patient presented with a 9-month history of painful erythematous nodules on the extremities, joint pain and swelling, and weight loss. A highly elevated level of pancreatic lipase was found on the laboratory examinations. The biopsy specimens from the skin lesions showed subcutaneous fat necrosis. Abdominal computed tomography (CT) revealed a large mass with central necrosis in the body and tail of the pancreas. Distal pancreatectomy, splenectomy and partial transverse colectomy were successfully performed on day 17 of the hospitalization. The histopathologic findings supported the diagnosis of acinar cell carcinoma of the pancreas (ACCP). Postoperatively, the level of serum lipase returned to normal, and the skin lesions and joint manifestations gradually regressed. However, the swelling did not significantly resolve in the left knee. In view of the non-specific clinical presentation of this disease, clinicians should be alert and have a high index of suspicion for pancreatic panniculitis.

Hypercalcemia and metastatic calcification in a neonate with subcutaneous fat necrosis.

We report a 30-day-old baby with subcutaneous fat necrosis and symptomatic hypercalcemia, who developed metastatic calcification in the subcutaneous tissue, kidneys, pericardium and brain. The baby also had anemia, hypertriglyceridemia and hypercholesterolemia. He was managed with intravenous saline, furosemide, oral steroids and bisphosphonates and improved with treatment.

Subcutaneous Fat Necrosis of the Lower Eyelid Associated with Anemia

PURPOSE: Subcutaneous fat necrosis is rare. To our knowledge, there is no report of subcutaneous fat necrosis on the lower eyelid. We report a case of subcutaneous fat necrosis of the lower eyelid related to anemia. CASE SUMMARY: A 52-year-old female patient presented with palpable masses in both lower eyelids that had persisted for the past year. The thin, shallow, plaque-like mass with a well-demarcated border was palpated on the subcutaneous tissue of both lower eyelids. There was no tenderness or signs of inflammation. histopathologically, there were variously sized fat vacuoles with mild cellular infiltration. The mass was determined to be caused by subcutaneous fat necrosis. The patient had no unusual past history except a total gastrectomy 2 years previously. We performed a blood test and detected chronic anemia. CONCLUSIONS: We report a case of chronic subcutaneous fat necrosis related to anemia. When clinicians detect the subcutaneous fat necrosis, a work-up on hematological factors affecting lipid metabolism should be performed.

A Case of Pancreatic Panniculitis / 대한피부과학회지

Pancreatic panniculitis is a subcutaneous fat necrosis associated with pancreatic disease. We report a case of pancreatic panniculitis associated with chronic pancreatitis. The patient was a 47-year-old man who was a severe alcoholic. He was diagnosed with chronic pancreatitis and inferior vena cava thrombosis 2 months before. He presented with multiple, tender, erythematous, subcutaneous nodules on both lower legs, and also had pitting edema with tenderness on the left ankle. Laboratory examination showed an increase in serum blood amylase and lipase. Histopathologic findings showed subcutaneous focal fat necrosis, dense neutrophil infiltration and anucleated "ghost cells". Stippled basophilic material was deposited in and around the necrotic subcutaneous fat tissue. The lesions subsided gradually with improvement of the chronic pancreatitis.

A Case of Subcutaneous Fat Necrosis of Newborn (SCFNN) Associated with Meconium Aspiration Syndrome / 대한피부과학회지

Subcutaneous fat necrosis of newborn (SCFNN) is a rare disease. Characteristically, full-term infants with associated perinatal problems such as hypoxia, hypothermia, and obstetric trauma are affected in the first week of life. We report a case of SCFNN, which presented as an erythematous subcutaneous mass on the back of a male neonate who suffered from meconium aspiration pneumonia with neonatal sepsis.

A Case of Generalized Subcutaneous Fat Necrosis of Newborn / 대한피부과학회지

Subcutaneous fat necrosis of newborn is an uncommon disorder characterized by firm subcutaneous plaques and nodules usually appearing shortly after birth. A female newborn with brain death developed diffuse hardening of trunk, extremity, cheek and buttock in the first 5 weeks of the life. A clinical diagnosis of sclerema neonatorum was made. But histologic examination revealed patchy areas of fat necrosis with crystallization, infiltration of histologic cells and several multinucleated giant cells containing needle-shaped clefts. Calcium deposits were also demonstrated within the necrotic area. So, we diagnosed this case as subcutaneous fat necrosis of newborn with generalized hardening of the skin.

A Case of Subcutaneous Fat Necrosis of the Newborn / 대한피부과학회지

Subcutaneous fat necrosis of the newborn is an uncommon transient panniculitis which is characterized by asymptomatic, firm to rubbery, purple-red, erythematous subcutaneous nodules and plaques occurring during the first 4 weeks of life. Characteristic histologic findings are areas of fat necrosis associated with inflammation in the subcutaneous tissue and needle-shaped clefts with radial arrangement in fat cells as well as foreign body giant cells. We report a case of subcutaneous fat necrosis in a 9 day-old male who had suffered from hard erythematous nodules on both upper arms.

A Case of Subcutaneous Fat Necrosis in Neonate with Meconium Aspiration Syndrome

Subcutaneous fat necrosis in neonates is a rare disease characterized by skin lesions, which may be single or multiple, poorly circumscribed and often tender erythematous nodules or plaques on cheeks, buttocks, back, arms, and thighs. These symptoms are usually self-limited; resolution occurs over a period of weeks to months. Subcutaneous fat necrosis affects full term and healthy- appearing infants who have experienced perinatal distress such as hypoxic insult, birth trauma and hypothermia. Most skin lesions appear within the first two weeks of life. We experienced a case of subcutaneous fat necrosis in a neonate with hypoxic insult and report the case with a brief review of the literature.

Subcutaneous Fat Necrosis of the Newborn Associated with Cardiomyopathy

Subcutaneous fat necrosis of the newborn is an uncommon disorder characterized by firm b-cutaneous plaques and nodules usually appearing shortly after birth. It runs a relatively be, n course and may completely resolve in a few months without any recurrence. We report a case of subcutaneous fat necrosis in a 15 day-old male suffering from severe p inatal asphyxia and hypoxic cardiomyopathy, who presented with indurated subcutane s nodules and plaques on the both shoulders and the back. Histologically the subcutaneous fat showed focal necrosis with needle-shaped clefts, lymphohistiocytic infiltration and foreign body reactions consistent with subcutaneous fat necrosis of the newborn. In our patient, compromised cardiac output due to cardiomyopathy might have aggravated hypoxic condition and it could be speculated that cardiomyopathy-induced systemic hypoxia gave rise to hypothermia of the skin as a result of peripheral vasoconstriction. This report presents a causal relationship of cardiomyopathy and subcutaneous fat necrosis of the newborn.

Subcutaneous Fat Necrosis Associated with Pancreatic Adenocarcinoma: A case report

Subcutaneous fat necrosis is manifested by erythematous tender nodules on the legs, buttock or trunk and is associated with pancreatic disease including acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, pancreatic stone and other diseases. Its histologic findings are pathognomonic and reveal foci of subcutaneous fat necrosis with "ghost-like" anucleated cells with thick "shadowy wall" and surrounding inflammatory infiltrate consisting of polymorphonuclear cells, eosinophils, lymphocytes, histiocytes, foam cells and foreign body giant cells. We experienced a case of subcutaneous fat necrosis associated with pancreatic adenocarcinoma manifested by subcutaneous nodules in the buttock and lower extremities and by arthralgia of the left knee in a 67-year-old woman. Therefore, we are reporting to emphasize the importance of the skin findings of the internal disease.

A Case of Subcutaneous fat Necrosis Associated with Pancreatitis

We report a case of subcutaneous fat necrosis associated with pancreatitis that may be the first case in Korean hterature as for we know. The patient was a 41-year-old man wbo presented erythema nodesum-like erythematous subcufaneous nodules on both lower extremities. Histopathologic findings showed subcutaneoms focal fat necrosis and ghoat-like cells. Granular basophilic material was deposited in and around the necrotic fat cells and stained positively with von Kossa stain. The lesioas subsided gradwdly without any specific treatment, as the underlying pancreatitis was ameliorated.

A Case of Subcutaneous Fat Necrosis of the Newborn / 대한피부과학회지

We report herein a case of subcutaneous fat necrosis in an 1-month-old abandoned female neonate who had subcutaneous nodule on the right cheek and linear cord-like subcutaneous nodule on the right upper arm which has been evident from the second post-delivery day. Hiatopathologic findings revealed massive subcutaneous fat necroais with infiltration of foreign body giant cells and inflammatory cells. Calcigm was also deposited but no needle shaped cleft was formed in the fat cells. The akin lesion resolved spontaneously after 2 months.