title: Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications.
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.
  
  
  METHODS
  Chart review of all infants with SCFN seen at a single paediatric centre over a 13-year period.
  
  
  METHODS
  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.
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Shumer
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Vidhu
authors.initials: V
authors.lastname: Thaker
authors.affiliation: Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Taylor
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Ari J
authors.initials: AJ
authors.lastname: Wassner
mesh_terms: D005218:Fat Necrosis / Q000150:complications*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009397:Nephrocalcinosis / Q000209:etiology; D015434:Panniculitis / Q000150:complications; D050151:Subcutaneous Fat / Q000473:pathology
keywords: Dermatology; Endocrinology; Neonatology; Nephrology