Session: SUN 723-739-Lipids: Therapeutics & Case Reports
Poster Board SUN-737
Index Case: A 53 year old postmenopausal female of Scottish descent was referred for abnormal adipose accumulation. Over one year, she rapidly developed soft tissue masses progressing from the base of her neck to her shoulders and upper arms. She subsequently was found to have decreased muscle strength, requiring assistance of handrails and inability to do sit-ups. She limited her time in public due to her appearance. The social history was notable for consumption of two glasses of wine per night for twenty years.
Physical exam was notable for extensive fat accumulation on the neck, shoulders, arms and upper back. The fat was fixed and non-tender. Lab and Imaging results were significant for transaminase elevation and hyperlipidemia. Abdominal ultrasound showed no evidence of fatty liver. The CT of the neck showed fat extending from the posterior cervical spine musculature to the upper chest. It was isodense to subcutaneous fat without clear separation.
Upon review of the 11 other male cases, each patient presented in a similar fashion after years of alcohol use. They had symmetric excess subcutaneous fat tissue localized to posterior neck, posterior cervical and upper back, and abdomen. Interestingly, half of these patients were noted to have bilateral discrete fat localized in the popliteal fossa.
Conclusion: The index case describes a typical presentation of Multiple Symmetric Lipomatosis. It is also somewhat unique as the patient is a Non Mediterranean female (normally 15:1 male to female ratio). There have been three types of lipomatosis described based on the predominant location of fat deposition. Type 1 is fat localized to head/neck; type 2, fat is localized to the shoulder girdle, upper arms, thorax, back, abdomen and upper buttocks; and type 3 have fat in the upper thigh. Considering that half of our patients had fat in the popliteal fossa, this bizarre location could serve as a new pathognomonic physical finding with diagnostic utility.
Nothing to Disclose: SMG, KLB, ESN, MSI
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