A 2-week-Old With Right Upper Extremity Swelling and Discoloration

In this case report, we present a 2-week-old female ex-34w6d mono-di twin who is brought by her parents to the pediatric urgent care department due to sudden right upper extremity swelling, firmness, and bruising. Ultrasound of the right extremity reveals "mild subcutaneous edema in the subepidermal soft tissues with multiple scattered echogenic foci present" and X-ray of the right upper extremity reveals "increased density in the soft tissues around the humerus which may represent calcification". After discussion with several inter-disciplinary team members, it was determined that this patient had iatrogenic calcinosis cutis from a prior intravenous calcium gluconate infusion in the NICU, which occurs when insoluble calcium salts are deposited into tissue and can form hard palpable nodules that can impinge nerves and blood vessels and affect movement, sensation, and blood flow. Importantly, this is a rare complication that can occur, especially in neonates, and we hope to add to the growing literature on its recognition and subsequent management.