Severe hypercalcemia and nephrocalcinosis secondary to subcutaneous fat necrosis in a neonate with perinatal asphyxia: a case report

Amal Prazad; Aswathy Mathews

doi:10.18203/2320-6012.ijrms20262209

Authors

Amal Prazad Department of Emergency Medicine, Memorial Health System, Marietta, Ohio, United States of America https://orcid.org/0009-0001-3742-4005
Aswathy Mathews Department of Internal Medicine, Government Sivagangai Medical College, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20262209

Keywords:

Subcutaneous fat necrosis, Hypercalcemia, Nephrocalcinosis, Hypoxic–ischemic encephalopathy, Newborn

Abstract

Subcutaneous fat necrosis of the newborn (SCFN) is a rare, self-limiting panniculitis that occurs predominantly in full-term neonates following significant perinatal stress. Although the cutaneous manifestations often resolve spontaneously, SCFN can be complicated by severe and potentially life-threatening metabolic derangements, particularly hypercalcemia. We report the case of a 2.5-month-old female infant with a history of Grade 3 hypoxic–ischemic encephalopathy (HIE) who presented with multiple indurated subcutaneous nodules and profound hypercalcemia complicated by bilateral medullary nephrocalcinosis. Biochemical evaluation demonstrated suppressed parathyroid hormone levels with markedly elevated 1,25-dihydroxyvitamin D, consistent with PTH-independent hypercalcemia due to extra-renal vitamin D activation. Prompt recognition and aggressive multimodal therapy, including hyperhydration, calcitonin, and systemic corticosteroids, resulted in normalization of serum calcium levels. This case underscores the importance of early diagnosis, vigilant metabolic monitoring, and timely intervention in neonates with SCFN to prevent irreversible renal complications.

Author Biography

Amal Prazad, Department of Emergency Medicine, Memorial Health System, Marietta, Ohio, United States of America

PGY2, Emergency Medicine, Memorial Health System, Marietta, USA

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