Sclerema Neonatorum in a Term Infant: A Case Report and Literature Review

Sclerema neonatorum (SN) is a rare form of panniculitides with an obscure incidence, aetiology, and pathogenesis. This condition is peculiar to preterm neonates, especially those with comorbidities such as sepsis, congenital anomalies, congenital heart disease, and gastrointestinal and respiratory diseases. Usually, it presents within the first seven days of life, but may develop a few weeks later. Typically, SN manifests with diffuse hardening of the skin and subcutaneous tissues that subsequently bind to the underlying muscle and bone, often beginning in the buttocks, thighs, or trunk, and progressing to other body parts, but sparing the soles, palms, and genitalia. Diagnosis is based on clinical characteristics. It has been associated with a high mortality, despite aggressive use of various treatment modalities such as antibiotics, steroids, fresh blood transfusion, exchange blood transfusion, and intravenous immunoglobins. This is a report of a macrosomic term neonate who presented with typical clinical and histopathological features of SN.

Neonatal Cellulitis

Introduction: Newborn cellulitis is rare and often atypical disease. It is a diagnostic and therapeutic emergency and its progress leads to instant death. We report three cases of neonatal cellulitis from the Neonatal ICU Department of Mohammed VI university hospital in Marrakesh, highlighting this rare, serious and unknown disease. Case 1: 17-day-old female newborn admitted for sepsis and breast refusal since 5 days. Clinical examination revealed a hypotonic newborn, hypothermic at 34.2 °C with sclerema neonatorum. Skin examination found Erythema and edema on the left hemi-face with necrosis of the ipsilateral nostril. The blood culture had isolated coagulase-negative staphylococci. The newborn was put under triple antimicrobial therapy of 3rd Generation Cephalosporin (3GCs), gentamicin and vancomycin with good progress. Case 2: 20-day-old male newborn, was circumcised ten days before admission, had sepsis with a fever at 40 °C evolving since 24h. The clinical examination found hard, hot and very painful inflammatory lesion starting at the scrotum and extending to suprapubic region and the start of the lower limbs. Blood tests revealed strongly positive infectious status. The progress was positive when put under triple antimicrobial therapy. Case 3: 25-day-old female newborn, visited a traditional healer who gave her a mixture of unknown nature to apply on her face, hospitalized in our department for cellulitis of the right hemi-face extending to the periorbital and cervical region evolving since two days together with a fever. Infectious blood assessment was positive. The progress was favorable when put under triple antimicrobial therapy. Conclusion: Cellulitis is a rare disease in newborn and it must be diagnosed early because it can be complicated into sepsis. The search for other localizations, mainly meningeal, is essential.

Newborn With Enlarged Erythematous Mass on Back: Case Report and Review of Medical Literature

Newborn skin nodules are usually benign and self-resolving skin condition. Differential diagnosis of such lesions include cysts, hemangioma, abscess, cellulitis, sclerema neonatorum, subcutaneous fat necrosis, neurofibromatosis, benign tumors, or malignant tumors such as rhabdomyosarcoma, infantile fibrosarcoma, or neuroblastoma. We report a case of congenital subcutaneous fat necrosis in a 7-day-old baby presenting with multiple erythematous mass on back.

Sclerema Neonatorum Treated Successfully with Parenteral Steroids: An Experience from a Resource Poor Country

Sclerema neonatorum is a form of panniculitides characterized by diffuse hardening of subcutaneous tissue with minimal inflammation. It usually affects ill and preterm neonates. Prognosis is usually poor in many cases despite aggressive management. Various treatment modalities (antibiotics, intravenous immunoglobulin, steroids, and exchange transfusion) have been explained in literature. Steroids due to its easy availability and low cost can prove to be lifesaving in such cases, especially in resource poor countries. Here, we report a case of sclerema neonatorum in a one-week preterm baby treated successfully with parenteral steroids and antibiotics.