Publication:

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

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.