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Congenital Volkmann ischemic contracture is a rare condition in which a neonate presents with an ulcerated forearm, necrotic subcutaneous tissue, nerve palsy, and muscular necrosis. We report a case of a 1-day-old infant who presented with an ulceration of the left forearm noted at delivery combined with decreased motor function of the left distal forearm. Histologic examination of the ulceration revealed findings of subcutaneous fat necrosis of the newborn. To our knowledge, this is the first case for which the findings of subcutaneous fat necrosis have been seen histologically.

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We describe the ultrasonography, the contrast-enhanced computed tomography and the magnetic resonance imaging of subcutaneous fat necrosis in a newborn infant.

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In the course of a connatal pneumonia, a 7-day-old female newborn developed symmetrical subcutaneous nodules on her back, shoulders, and upper arms. These skin lesions were accompanied by hypercalcemia. Histological examination confirmed the putative clinical diagnosis of subcutaneous fat necrosis of the newborn. We discuss the differential diagnoses, therapeutic strategies, and prognosis of this uncommon disorder of the fat tissue.

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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.

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Hypercalcemia is occasionally found in newborns with subcutaneous fat necrosis and carries potential life-threatening risk. Bisphosphonates have been recently introduced in the treatment of subcutaneous fat necrosis in newborns. We report a case of extensive subcutaneous fat necrosis in a female infant complicated with intractable hypercalcemia. Standard treatment for hypercalcemia was given, including saline hydration, a low calcium diet, furosemide, and glucocorticoid, but without response. Serum 1,25-dihydroxyvitamin D level was elevated at 126 pg/mL, 25-hydroxyvitamin D level was normal, and intact parathyroid hormone was suppressed at < 1 pg/mL. Oral clodronate disodium, a second-generation bisphosphonate, was administered, and resulted in the normalization of serum calcium, urine N-telopeptide, urine calcium/creatinine ratio, and serum intact parathyroid hormone level. This case suggests that oral clodronate may be an effective treatment for subcutaneous fat necrosis with hypercalcemia in newborns.

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CHARACTERISTICS: Cytosteatonecrosis of the newborn (CSNN) is an acute hypodermatitis that appears within the first four weeks of life. It essentially develops in infants born at term or postmature, and following a difficult delivery. THE LESIONS: The lesions are more or less extended sub-cutaneous nodules or inflammatory plaques on the body that regress spontaneously, without after effects, within one to four months. A cutaneous biopsy, rarely required for diagnosis, reveals a granulomatous reaction to a foreign body in a necrosed subcutaneous adipose tissue. EVOLUTION: Although the progression is generally benign, it may be complicated by the occurrence of hypercalcemia. The management of these infants justifies the regular monitoring of blood calcium levels and treatment of an eventual hypercalcemia.

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A neonate, born from a mother with hypertension during the last trimester of gestation, presented with ulcerated lesions on the right lower limb that had been present since birth. The baby also had necrosis of the fifth toe of the right foot and generalized muscle hypoplasia of the entire limb. The histologic appearance of the cutaneous lesions was diagnostic of subcutaneous fat necrosis of the newborn. The congenital presence of subcutaneous fat necrosis is exceptional, and to date, ulcerated forms have not been reported in the literature.

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We present the CT findings in two newborns with subcutaneous fat necrosis. This is an uncommon disease that occurs in neonates who have had difficult deliveries. The CT findings varied from discrete subcutaneous nodules to a diffuse subcutaneous fullness. Although the subcutaneous disease tends to spontaneously resolve within weeks to months, an associated hypercalcemia may have a fatal outcome.

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