Tender Skin Nodules in a Newborn
A 9-day-old male baby presented to us with an inconsolable cry. He was a full-term singleton delivered by cesarean section with a history of birth asphyxia. His mother had an uneventful antenatal period. Early postnatal events were otherwise normal, and the baby had been feeding well. The baby's crying aggravated on being handled or kept in the supine position. On examination, we found numerous tender purple-colored plaques and nodules over the back, buttocks, and upper thigh []. No other systemic abnormality that explained the crying was found on detailed examination. Routine blood, urine, and stool examinations were normal. Hypercalcemia was found, which persisted in spite of proper hydration and administration of frusemide in a dose of 1 mg/kg/body weight daily. A punch biopsy was done from a plaque over the back. Histology showed a normal epidermis. Lobular panniculitis was seen with a dense infiltrate of lymphocytes, histiocytes, and multinucleate giant cells [].\nWe started corticosteroid in the form of prednisolone (Dose-1 mg/kg/day in 2 divided doses orally). To relieve the pain, we prescribed acetaminophen (15 mg/kg/dose 4 times daily) and triclofos (50 mg/kg/dose). Breastfeeding was continued, and hydration was maintained. The baby gradually became symptom-free after 8 days of admission. Serum calcium level which was initially 12.4 mg/dl persisted for a week at that level before decreasing to 12 mg/dl at the end of 2 weeks and 11.4 mg/dl at the end of 4 weeks. The dose of prednisolone was gradually tapered over a period of 2 weeks, and the baby was discharged. Regular follow-up and routine check of serum calcium levels was done thereafter. The serum calcium levels decreased to 9.4 mg/dl at the end of 6 months and remained stable at that level thereafter. We followed him up for the next 18 months, and there was no recurrence till then.