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Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications
  1. Daniel E Shumer1,
  2. Vidhu Thaker1,
  3. George A Taylor2,
  4. Ari J Wassner1
  1. 1Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Ari J Wassner, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; ari.wassner{at}childrens.harvard.edu

Abstract

Objective Subcutaneous fat necrosis (SCFN) is a rare form of panniculitis in infants that generally occurs following birth trauma, meconium aspiration, or therapeutic cooling. Severe hypercalcaemia occurs in a subset of patients, but data on its presentation, management and outcomes are limited. This report details the clinical course and complications of infants treated for severe hypercalcaemia (peak serum calcium ≥3.0 mmol/L) due to SCFN.

Design Chart review of all infants with SCFN seen at a single paediatric centre over a 13-year period.

Patients Seven infants with SCFN developed severe hypercalcaemia, with median peak serum calcium 4.1 mmol/L (range 3.3–5.1).

Results Severe hypercalcaemia occurred before 6 weeks of age, and was asymptomatic in 3/7 patients (43%). Most patients were treated with intravenous hydration, furosemide, glucocorticoids and low-calcium formula, which restored normocalcaemia in a median of 9 days (range 2–42). Fever developed during treatment in 4/7 infants (57%): two patients had bacterial infections and two had no infectious source identified. Nephrocalcinosis was present in 5/6 patients (83%) who were evaluated by renal ultrasound. Nephrocalcinosis failed to resolve in all cases over a median follow-up of 20 months (range 8–48), but no renal dysfunction was observed. Eosinophilia, which has not been reported previously in SCFN, was present in 6/7 patients (86%).

Conclusions In this largest series to date of infants with severe hypercalcaemia due to SCFN, novel findings include the common occurrence of fever and a high incidence of persistent nephrocalcinosis without evidence of adverse renal outcomes.

  • Endocrinology
  • Dermatology
  • Nephrology
  • Neonatology

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