We present two patients with subcutaneous fat necroses (SCFN) in whom endocrinologic studies revealed an association with elevated
prostaglandin E (
PGE) levels. A boy born after prolonged labor complicated by
meconium aspiration developed erythematous, indurated plaques over the back, arms, buttocks, and cheeks at 4 days of age. A biopsy specimen of involved skin showed
panniculitis with foci of necrotic adipocytes containing radially arranged, needle-shaped clefts and a granulomatous infiltrate in the septae. Laboratory studies revealed
hypercalcemia of 13.6 mg/dl (normal 8.8-10.1 mg/dl), elevated 1.25-1.25(OH)2D3, and increased urinary excretion of
PGE2. The child was hospitalized and treated with systemic
steroids and
diuretics, with resolution of SCFN and
hypercalcemia. The second patient was a girl born with cyanotic
heart disease. A diagnosis of
Ebstein anomaly was made, and intravenous
PGE1 was started to keep patent the ductus arteriosus. Four days later erythematous, indurated plaques were noted on the knee, back, and anterior chest. A skin biopsy specimen revealed SCFN. There was no associated laboratory abnormality. On discontinuing
PGE1, no new lesions formed and the existing
panniculitis resolved. These two cases demonstrate the association between SCFN and elevated
PGE levels (endogenous in patient 1, exogenous in patient 2). No previous reports of SCFN after the administration of
PGE1 have appeared in the literature.