Can you identify this acute widespread nodular rash on a neonate who is otherwise ready for discharge?
A former resident calls you from her new rotation in the nursery to come and see a neonate with a perplexing dermatologic condition.
2-week-old infant had stressful delivery, including mild hypoxia. Birth weight, 4.5 kg, delivered via C-section. Rash onset has been acute.
Note firm, inflamed, nodules on back that range in color from skin-toned to purple; skin is peeling over most involved areas
Noted over rib cage are several firm violaceous nodular lesions that may reflect a pressure point at the time of delivery.
Clues to Dx: newborn large-for-gestation, stressed at delivery, not septic, feeding well, vitals are normal; no sign of systemic disease.
Differential Dx: Bacterial cellulitis, erysipelas, infantile hemangioma, rhabdomyosarcoma, sclerema neonatorum, subcutaneous fat necrosis.
Answer: Subcutaneous fat necrosis of the newborn (SFNN) is an uncommon disorderPossible risk factors: perinatal asphyxia, meconium aspiration, cord accidents, hypothermia/cold
SFNN is a form of panniculitis; Exact cause unknown. More common factors seen are: fetal stress during delivery, low oxygen levels, cold temperature, C-section, high birth weight, infection.
SFNN nodules may be painful, resolve spontaneously but may last weeks-months. Compications are rare; hypercalcemia most dangerous; after skin lesions have healed; blood calcium should be monitored after skin lesions clear.
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?Â Please avoid scrolling down for references until you've finished reading the case. Â Â Â Â Â Â Â
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