Severe Hypercalcemia in an Infant with Subcutaneous Fat Necrosis: Successful Management with Bisphosphonate Treatment

Subcutaneous fat necrosis (SFN) in infancy is a rare condition and usually presents with panniculitis, especially within the first few weeks of life. These skin lesions may improve spontaneously but the most life- threatening complication of SFN is severe hypercalcemia. Here, we report the case of an infant with severe hypercalcemia due to SFN. The infant was managed for sepsis and evaluated for nodular erythematous skin lesions, which revealed SFN. Hypercalcemia was severe and unresponsive to the usual treatment regimens. Therefore, bisphosphonate (pamidronate) was used to correct the hypercalcemia. Hypercalcemia is a serious complication in SFN and needs prolonged follow-up. Calcium levels should be monitored regularly in these patients. We report that pamidronate may be appropriate as the first line therapy to treat severe hypercalcemia due to SFN.