Chalky-Yellow Nodules on a Neonate

A 12-day-old boy presented with yellow granular deposits on his left elbow and over the right and left sides of his forehead. These lesions corresponded to previous intravenous (IV) line sites. He had been delivered at 37 weeks' gestational age to a gravida 3, para 2-3 mother after artificial rupture of membranes. The pregnancy was complicated by maternal cholelithiasis and Rh incompatibility. The immediate neonatal period was complicated by hypotension, presumably due to sepsis. The patient was treated with intravenous ampicillin and gentamicin sulfate for 10 days. On day 5 of life, hypocalcemia was diagnosed (ionized calcium level, 3.31 mg/dL [0.83 mmol/L]). Over the next 2 days, 10% calcium gluconate was administered by peripheral IV over a 1-hour period every 6 hours. On day 7 of life, the first granular deposits were noted on the patient's left elbow.

On physical examination, firm, yellow papules were noted over the left elbow (Figure 1) and the left side of the forehead. Over the right eyebrow, there was a hard 4-mm subcutaneous nodule surrounded by white-yellow linear plaques in a vascular distribution. There was also a 1-cm yellow plaque with central necrosis on the lateral aspect of the right temple (Figure 2). On day 12 of life, a 3-mm punch biopsy specimen was obtained from the lesion on the left elbow (Figure 3).

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