Newborn with bilateral cheek swelling

Introduction We report a subcutaneous fat necrosis of the newborn (SCFN) affecting both cheeks of a newborn with diabetic fetopathy.

Case A 30-day-old mature newborn (38+1 weeks of gestation) has been presented with known postpartum asphyxia, diabetic fetopathy, primary pulmonary hypertension and cardiomyopathy because of bilateral cheek swelling since birth. Gll. parotideae and submandibulares were not enlarged but there was a symmetrical hardening palpable in the area of ??the cheeks. Duplex sonography examination showed a solid, high echogenic, poorly textured tissue of 1-1,5cm with discrete vascularization and sharp boundary. Supplementary MRI imaging assessed the lesion as a circumscribed adipose tissue proliferation in the buccinator area. Laboratory tests showed hypercalcaemia. The treating pediatricians reported a decayed rash in the trunk area, therefore a SCFN mainly affecting the buccinator area could be diagnosed. Treatment was performed by systemic prednisolone administration. Meanwhile, the infant was discharged with stable laboratory parameters and declining local findings.

Conclusions SCFN is a rare disease that affects especially mature newborns after birth stress. In the present case, a bilateral, symmetrical swelling in the cheek area was clinically impressive, which palpably did not correspond to the soft findings of a lipoma. The disease is benign but may lead to complications such as growth restriction and kidney failure because of associated hypercalcaemia.

SCFN is described only in sporadic cases. It represents a rare differential diagnosis of facial swelling in neonates, which may be treated either by a “wait-and-see” strategy or with systemic anti-inflammatory treatment.

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Publication History

Article published online:
07 August 2020