The Mysterious Case of a Lumpy Newborn

May 26, 2016

Can you identify this acute widespread nodular rash on a neonate who is otherwise ready for discharge?

An otherwise healthy 2-week-old infant is ready for discharge but that morning is found to have an alarming widespread, violaceous rash. Dr Jon Schneider was ready to head home late that same day when a former resident called and appealed to his keen interest in dermatology.Head to the opposite side of the university hospital with him and see the child as the resident, now in the nursery, fills you in on the perinatal particulars. What's in your differential Dx? Please avoid scrolling down for references until you've finished reading the case.        

References:

Akın MA, Akin L, Sarıcı D, Yilmaz I, et al. Follow-up during early infancy of newborns diagnosed with subcutaneous fat necrosis. J Clin Res Pediatr Endocrinol. 2011;3:216–218. Published online 2011 Dec 6. doi:  10.4274/jcrpe.355

Bachrach LK, Lum CK. Etidronate in subcutaneous fat necrosis of the newborn. J Pediatr. 1999;135:530-1.

Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol. 1999;16:384-7.

Hogeling M, Meddles K, Berk DR, et al. Extensive subcutaneous fat necrosis of the newborn associated with therapeutic hypothermia. Pediatr Dermatol. 2012;29:59-63.

Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn-an unusual case and review of literature. Eur J Pediatr. 2011;170:1107-10. doi: 10.1007/s00431-011-1405-x. Epub 2011 Feb 12.

Strohm B, Hobson A, Brocklehurst P, Edwards AD, Azzopardi D, UK TOBY Cooling Register. Subcutaneous fat necrosis after moderate therapeutic hypothermia in neonates. Pediatrics. 2011;128:e450-2