Am J Perinatol 2019; 36(S 02): S134-S138
DOI: 10.1055/s-0039-1691777
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of Zoledronic Acid in a Neonate with Subcutaneous Fat Necrosis Complicated with Severe, Refractory Hypercalcemia

Maria Angela Militello
1  Division of Pediatrics, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
,
Maria Paola Re
2  U.O.C. Neonatologia - TIN - Nido, ARNAS Civico, Palermo, Italy
,
Giuliana Vitaliti
3  Dipartimento di Scienze per la Promozione della Salute e Materno Infantile G. D'Alessandro, University of Palermo, School of Medicine, Palermo, Italy
,
Francesca Finazzo
2  U.O.C. Neonatologia - TIN - Nido, ARNAS Civico, Palermo, Italy
,
Paolo Manzoni
1  Division of Pediatrics, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
,
Salvino Marcello Vitaliti
2  U.O.C. Neonatologia - TIN - Nido, ARNAS Civico, Palermo, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
25 June 2019 (online)

Abstract

Objective Subcutaneous fat necrosis (SCFN) is a rare condition that may occur in the neonatal period. SCFN is an inflammatory disorder of the adipose tissue, usually found in full-term healthy infants who have a history of intrauterine or perinatal distress. It is usually a self-limited condition; however, in some cases, it can get complicated, leading to severe hypercalcemia that may be life-threatening.

Study Design We report and describe a classic presentation of SCFN that led to severe hypercalcemia refractory to standard treatment. The diagnosis of SCFN was made based on the finding of subcutaneous nodules and of hypercalcemia. The serum calcium level reached 16.6 mg/dL. Hypercalcemia was treated first with intravenous infusions of fluids and furosemide and then of methylprednisolone. This standard treatment was not effective; therefore, we administered a single low dose of zoledronic acid, which, in turn, was efficacious in ultimately managing the hypercalcemia.

Conclusion Our case shows how a single low dose of zoledronic acid was safe and effective in managing severe hypercalcemia unresponsive to conventional treatment while minimizing the risk of hypocalcemic rebounds.