[Benign symmetrical lipomatosis ("peripheral lipodystrophy") during antiretroviral therapy of HIV infection].

Abstract

HISTORY AND ADMISSION FINDINGS:

A 29-year-old hemophiliac with HIV infection for which he was receiving antiretroviral treatment (ART) with indinavir, zidovudine and zalcitabine reported increasing swelling of the neck. Physical examination noted a soft to doughy swelling, not sensitive to pressure, extending from the neck to between the shoulder blades.

INVESTIGATIONS:

Ultrasonography and magnetic resonance imaging revealed the swelling to consist of an accumulation of subcutaneous fat without capsule. Cytology demonstrated benign fatty tissue. Blood triglycerides totalled 667 mg/dl.

DIAGNOSIS, TREATMENT AND COURSE:

The typical location, absence of a capsule and the cytological finding confirmed the clinical diagnosis of drug-induced benign symmetrical lipomatosis (BSL, also called peripheral lipodystrophy) in ART. A connection with the hyperlipoproteinaemia is supported by the observation that the patient used to have a normal fat metabolism; the onset of BSL coincided with a massive increase in triglyceride levels. The hyperglyceridaemia and clinical signs improved on a low-fat diet.

CONCLUSIONS:

BSL can occur in the course of ART in HIV infection, when reverse-transcriptase inhibitors or protease inhibitors are being taken. Medication should not be changed, when antiretroviral treatment is adequate. To reduce the symptoms low-fat diet should be tried, as well as administration of HMG-CoA-reductase inhibitors or, if necessary, surgical liposuction.

• Authors: T Fischer, H Schwörer, G Ramadori
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 123 Issue 50 Pg. 1512-6 (Dec 11 1998) ISSN: 0012-0472 [Print] Germany
• Vernacular Title: Benigne symmetrische Lipomatose ("peripheral lipodystrophy") bei antiretroviraler Therapie der HIV-Infektion.
• PMID: 9879280 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Anti-HIV Agents
• Zidovudine
• Indinavir
• Zalcitabine

Topics

• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Drug Therapy, Combination
• HIV Infections (drug therapy, etiology)
• Hemophilia A (complications)
• Humans
• Indinavir (adverse effects, therapeutic use)
• Lipomatosis, Multiple Symmetrical (chemically induced, diagnosis)
• Male
• Zalcitabine (adverse effects, therapeutic use)
• Zidovudine (adverse effects, therapeutic use)