Cytological diagnosis of subcutaneous fat necrosis of newborn: a case report

Cytological findings of subcutaneous fat necrosis of the newborn, a rare and transient disorder of neonates, is described in a 20-day-old male baby, who presented with a 2-week history of firm, erythematous nodules and plaques on the back and upper arms.     

Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature

Subcutaneous fat necrosis of the newborn is an uncommon, self-limited panniculitis of neonates. Rare complications such as hypercalcemia, thrombocytopenia, hypertriglyceridemia, and hypoglycemia have been reported. We describe the first case where all of the above complications were encountered in the same infant. Physicians caring for infants with subcutaneous fat necrosis of the newborn should be aware of the above associations in order to provide prompt and appropriate treatment to prevent associated, undesirable sequelae.     

Rapid cytologic diagnosis of subcutaneous fat necrosis of the newborn

Subcutaneous fat necrosis of the newborn is a rare self-limited panniculitis that classically presents within the first few weeks of life. The diagnosis is typically clinical, but some cases require skin biopsy with hematoxylin and eosin stain for confirmation. We report a previously undocumented rapid diagnostic protocol that involves collecting a small amount of exudate from a suppurative lesion, placement onto a slide without fixation, and simply viewing the material under a microscope. This novel and practical method of diagnosis reveals doubly refractile crystals diagnostic of subcutaneous fat necrosis without a biopsy, which may be helpful for rapid diagnosis or use in low resource settings.     

Extensive subcutaneous fat necrosis of the newborn associated with therapeutic hypothermia

Subcutaneous fat necrosis of the newborn is a form of panniculitis that most often occurs in full-term infants with predisposing risk factors. Three neonates with hypoxic ischemic encephalopathy were treated with therapeutic hypothermia and developed extensive subcutaneous fat necrosis. All three infants developed extensive subcutaneous fat necrosis, involving the back, scalp, and arms. Mild, asymptomatic hypercalcemia was noted in one infant in the weeks following the subcutaneous fat necrosis. Hypothermia as a risk factor for subcutaneous fat necrosis is reviewed. Clinicians should be aware of subcutaneous fat necrosis as a possible risk factor and complication associated with asphyxiated newborns who may undergo therapeutic hypothermia. Future studies for therapeutic hypothermia should evaluate neonates for the development of subcutaneous fat necrosis.     

Painful subcutaneous fat necrosis of the newborn associated with intra-partum use of a calcium channel blocker

Subcutaneous fat necrosis of the newborn (SCFN) is a relatively uncommon condition of the skin which is said to be benign and painless. We report an infant with extremely painful SCFN which was relieved only by opiate analgesia. SCFN normally resolves spontaneously within a few weeks. This case is, therefore, also unusual in that symptoms persisted beyond 6 months.     

Subcutaneous fat necrosis of the newborn

Subcutaneous fat necrosis of the newborn (SFN) is an uncommon disease that affects newborns who have suffered from tissue hypoxia during or following delivery. This disease appears during the first weeks of life. It consists of indurate, erythematous or purple-erythematous nodules and plaques in the skin. Histology of a biopsy specimen shows granulomatous necrosis in the subcutis with radial crystals in lipocytes and giant cells. Spontaneous resolution in a few weeks is usual, but the mobilization of calcium from the necrosed subcutis together with the action of some hormones may cause hypercalcemia and certain serious complications. A newborn female child developed SFN after dystocic delivery causing cerebral frontal lobe hemorrhage. The skin nodules resolved spontaneously in a few weeks and no complications were observed 1 year later.     

Subcutaneous fat necrosis of the newborn

I. A group of twenty-one Caucasian volunteers was patch tested without preliminary sensitization with 3, 10, 30, 50 and 90 mug 2,4-dinitrochlorobenzene (DNCB)/cm2. Of this group seven persons were read after 24 h; with one exception all showed a toxic erythematous reaction to 30 mug and higher amounts of DNCB/cm2. The other fourteen volunteers were read after 48 h. All except one reacted positively to 30 mug and higher amounts of DNCB/cm2. Histologically no changes could be noted after application of 3 and 10 mug DNCB/cm2; they started to appear in patch tests with 30 mug DNCB/cm2 or more. II. A second group of twenty-one Caucasian volunteers was sensitized with 2000 mug DNCB on a surface area of 3-14 cm2. Biopsies were performed after 1 h, 5 h, 1 day and then daily for 17 days. The histological changes occurring in the sensitization site during the primary irritant reaction of the first days were compared with the changes occurring during the flare-up reaction. No essential qualitative differences could be noted. III. Four Caucasian volunteers were sensitized with 2000 mug DNCB on 3-14 cm2. Fourteen days later challenge patch test doses of 3, 10, 30, 50 and 90 mug DNCB/cm2 were applied. Biopsies of the challenge sites were performed after 48 h. In contrast to the results in group I, histological changes could already be noted after challenge patch tests with 3 mug DNCB/cm2. The nature ofthe histological changes in primary irritant and allergic reactions to DNCB appeared to be identical and consisted of spongiosis, epidermal degeneration and lymphocytic infiltration around vessles and epidermal appendages and penetrating into the epidermal layers. It is concluded that, in order to avoid errors through misinterpretation, challenge patch tests with DNCB must be performed with low amounts, e.g. 3 or 10 mug/cm2.     

Subcutaneous fat necrosis of the newborn

The patient in this study was an 18-day-old healthy boy, delivered by caesarean section at 33 weeks gestation, and the product of a pregnancy complicated by gestational diabetes and preterm labor. At 10 days old, three dermal and subcutaneous nodules were noted on the midline of the back (Fig. 1). The nodules measured 1–3 cm in size; they were firm, mobile, and multilobulated in quality. The overlying epidermis was slightly erythematous, but otherwise appeared normal.
A skin biopsy obtained 8 days after the lesions were first noted is shown in Fig. 2(a); necrosis of the fat with giant cell formation and characteristic needle-shaped clefts within residual fat cells can be seen (Fig. 2b).     

Lipomembranous fat necrosis of the subcutaneous tissue

Lipomembranous fat necrosis (LMFN) is a special subtype of fat necrosis characterized by the development of pseudocystic cavities lined with hyaline-crenulated membranes. This regressive degeneration or localized destruction of adipose tissue has been reported as a focal phenomenon or, rarely, as an extensive one in several pathologic conditions of the subcutaneous tissue. LMFN is frequently observed in patients who have chronic sclerotic infiltrated plaques or tender subcutaneous nodules on the lower extremities, often diagnosed as lipodermatosclerosis. There is increasing evidence that it is a morphologic feature that cannot be related to any particular clinical setting, however. Multiple local or systemic events causing a compromise in the blood supply of the subcutaneous tissue have been incriminated. The current knowledge of the different disorders associated with LMFN is reviewed. The different postulated pathogenic mechanisms leading to LMFN are also discussed.     

Subcutaneous fat necrosis of the newborn: a review of 11 cases

Subcutaneous fat necrosis (SFN) of the newborn is uncommon and usually occurs in the first weeks of life following a complicated delivery. The frequency with which hypercalcemia develops as a complication is uncertain. We report the clinical features of SFN in 11 patients seen between 1991 and 1998. Ten were born by cesarean section and fetal distress was present in the majority. It was not possible to distinguish SFN from sclerema neonatorum by time of onset or related infant diseases. Hypercalcemia developed in four infants up to 7 weeks after the onset of SFN. Infants with this condition should be carefully monitored for hypercalcemia.     

Subcutaneous fat necrosis of the newborn with hypercalcemia

INTRODUCTION: Hypercalcemia associated with subcutaneous fat necrosis of the newborn is a well known but rare event. CASE REPORT: A newborn with a history of cesarean section, fetomaternal infection, neurological and respiratory distress was admitted with anorexia, adynamia, vomiting, polyuria and polydipsia at the age of 37 days. Physical examination showed red and violaceous infiltrated skin lesions. Skin biopsy revealed focal areas of fat necrosis with crystal-like structures. Calcium and 1,25 (OH(2) ) vitamin D serum levels were increased. Diagnostic of subcutaneous fat necrosis of the newborn with symptomatic hypercalcemia was made. Evolution was favorable after treatment including furosemide, prednisone and a diet low in calcium and vitamin D. DISCUSSION: Hypercalcemia must be detected in infants with subcutaneous fat necrosis. This major complication may have fatal outcome. Treatment of hypercalcemia includes dietary changes associated with classic treatment of hypercalcemia. Routine evaluation of serum calcium level is essential.     

Subcutaneous fat necrosis of the newborn: clinical and histopathological correlation

Subcutaneous fat necrosis of the newborn is a rare benign panniculitis found in term and post-term neonates. Diagnosis is based on clinical characteristics and specific alterations in the adipocytes, detected by anatomical pathology. Subcutaneous fat necrosis of the newborn can occur in uncomplicated pregnancy and childbirth. However, perinatal complications such as asphyxia, hypothermia, seizures, preeclampsia, meconium aspiration, and even whole-body cooling used in newborns with perinatal hypoxia/anoxia may be associated with this entity.