Cutaneous Calcinosis Caused by Parenteral Nutrition Extravasation in a Neonate Treated by Surgical Debulking: Report of a Case

Authors

  • Kulpreeya Sirichamratsakul Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
  • Wison Laochareonsuk Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla
  • Supika Kritsaneepaiboon Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla
  • Waricha Janjindamai Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla
  • Kanet Kanjanapradit Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla
  • Surasak Sangkhathat Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla

Keywords:

Calcinosis cutis, Parenteral nutrition, Surgery

Abstract

Calcinosis cutis is an abnormal deposition of calcium compounds in the subcutaneous tissue that can result from various causes, including malignancy, metabolic diseases, and iatrogenic. In this report, we described a case of calcinosis cutis occurring in a newborn infant following extravasation of parenteral nutrition in neonatal intensive care. Due to its large size and an impending loss of the overlying skin, surgical removal of the calcinotic mass, followed by a full-thickness skin grafting. Evidence from energy-dispersive X-ray spectroscopy suggested that extravasation of the parenteral nutrition and precipitation of calcium phosphate and calcium carbonate explained the pathophysiology of calcium salt precipitation. This report addresses a potential complication from parenteral nutrition extravasation and suggests early management that might prevent the necessity for a major operation.

References

Janigan DT, Perey B, Marrie TJ, et al. Skin necrosis: an unusual complication of hyperphosphatemia during total parenteral nutrition therapy. JPEN J Parenter Enteral Nutr. 1997;21(1):50-2.

Ahn KH, Park ES. A rare case report of neonatal calcinosis cutis induced by distant and delayed extravasation of intravenous calcium gluconate. Arch Plast Surg. 2021;48(6):641-5.

Harada K, Miyasaka E, Otsuka F. Calcinosis Cutis. Am J Med. 2020;133(9):e528-e9.

Al Hajj I, Abdelmaksoud A, Wollina U, et al. Idiopathic calcinosis cutis universalis in a female child: the first case report from Yemen. Int J Dermatol. 2023;62(4):579-80.

Ching DL, Wong KY, Milroy C. Iatrogenic calcinosis cutis following a neonatal extravasation injury. Br J Hosp Med (Lond). 2014;75(5):295.

Alghaith EA, AlQahtani GA, Omer JA. Iatrogenic calcinosis cutis in 9-month-old baby boy: a case report. J Med Case Rep. 2022;16(1):86.

Janigan DT, Perey B, Marrie TJ, et al. Skin necrosis: an unusual complication of hyperphosphatemia during total parenteral nutrition therapy. JPEN J Parenter Enteral Nutr. 1997;21(1):50-2.

Del Barrio-Diaz P, Moll-Manzur C, Alvarez-Veliz S, et al. Topical sodium metabisulfite for the treatment of calcinosis cutis: a promising new therapy. Br J Dermatol. 2016;175(3):608-11.

Garcia-Garcia E, Lopez-Lopez R, Alvarez-Del-Vayo C, et al. Iatrogenic Calcinosis Cutis Successfully Treated with Topical Sodium Thiosulfate. Pediatr Dermatol. 2017;34(3):356-8.

Xie CB, Kidacki M, Ring N, et al. Iatrogenic calcinosis cutis from extravasated phosphate-containing solution treated with topical sodium thiosulfate. JAAD Case Rep. 2021;17:31-3.

Elahmar H, Feldman BM, Johnson SR. Management of Calcinosis Cutis in Rheumatic Diseases. J Rheumatol. 2022;49(9):980-9.

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Published

2023-07-03

How to Cite

1.
Sirichamratsakul K, Laochareonsuk W, Kritsaneepaiboon S, Janjindamai W, Kanjanapradit K, Sangkhathat S. Cutaneous Calcinosis Caused by Parenteral Nutrition Extravasation in a Neonate Treated by Surgical Debulking: Report of a Case. Thai J Surg [Internet]. 2023 Jul. 3 [cited 2024 May 20];44(2):68-73. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/261222

Issue

Vol. 44 No. 2 (2023): April - June

Section

Case Reports

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