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Images in Dermatology
May 4, 2022

Subcutaneous Fat Necrosis of the Newborn

Author Affiliations
  • 1Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
  • 2Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
  • 3Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
  • 4Leo Foundation Skin Immunology Research Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  • 5Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
JAMA Dermatol. 2022;158(7):812. doi:10.1001/jamadermatol.2022.1240

A full-term male infant was delivered by emergency cesarean delivery owing to fetal distress. At delivery, the neonate had no spontaneous respiration or heartbeat and was cyanotic and floppy. The infant was resuscitated and gradually stabilized. Umbilical cord blood gas analysis showed severe metabolic acidosis.

Over the next couple of days, his C-reactive protein level increased (>20 mg/dL; to convert to mg/L, multiply by 10), and a broad infection screening was performed, including blood cultures, lumbar puncture, urine analysis, chest radiography, and abdominal ultrasonography. Empirical broad spectrum antibiotic and antiviral treatment was administered. No focus of infection was identified. From the tenth day, blood calcium levels were persistently elevated. On the sixteenth day of life, the neonate developed painful and slightly erythematous subcutaneous nodules on the upper back and posterior arms (Figure, A). Punch biopsy results revealed predominantly lobular panniculitis with rich infiltration of lymphocytes and macrophages. In addition, a mild granulomatous response was noted with scattered multinucleate giant cells (Figure, B), which was consistent with subcutaneous fat necrosis (SCFN) of the newborn.

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