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Subcutaneous fat necrosis, hypercalcemia, and prostaglandin E
H Sharata1, D C Postellon, K Hashimoto
1Department of Medicine, University of Wisconsin-Madison 53705, USA.
Pediatric Dermatology
|March 1, 1995
Summary
Subcutaneous fat necroses (SCFN) in infants are linked to elevated prostaglandin E (PGE) levels. This association was observed with both endogenous and exogenous PGE, suggesting a crucial role for this mediator.
Area of Science:
- Neonatology
- Dermatology
- Endocrinology
Background:
- Subcutaneous fat necrosis (SCFN) is a rare condition affecting newborns, characterized by indurated plaques.
- Endocrine and metabolic derangements can be associated with SCFN, but the underlying mechanisms are not fully understood.
Observation:
- Two neonates presented with SCFN, one with endogenous hypercalcemia and elevated prostaglandin E2 (PGE2) excretion, and another treated with exogenous prostaglandin E1 (PGE1) for congenital heart disease.
- Skin biopsies confirmed panniculitis with necrotic adipocytes and granulomatous infiltrate in both cases.
- The first patient's SCFN and hypercalcemia resolved with systemic steroids and diuretics.
- The second patient's SCFN resolved upon discontinuation of PGE1 infusion, with no new lesions forming.
Findings:
- These cases highlight a significant association between elevated prostaglandin E (PGE) levels and the development of SCFN.
- Endogenous PGE2 elevation was observed in a patient with SCFN and hypercalcemia.
- Exogenous PGE1 administration in a neonate with critical heart disease also preceded the onset of SCFN.
Implications:
- Elevated PGE levels, whether endogenous or exogenous, may play a causal role in the pathogenesis of SCFN.
- This finding suggests that monitoring PGE levels or considering PGE-lowering strategies might be beneficial in managing SCFN.
- The study is the first to report SCFN associated with PGE1 administration, opening new avenues for research into SCFN etiology and treatment.