Diffuse Symmetrical Lipomatosis: A Case Report Depicting the Potential for Severity

ABSTRACT Objective: Diffuse symmetrical lipomatosis, or Madelung disease, is a condition of benign lipoma formation that occurs around the shoulder girdle and can alter quality of life immensely. As surgery is the mainstay for treatment, recognition and education of this condition is needed in medical literature to expand future treatment modalities. Methods: Case report and review of the literature. Results: A 47-year-old male with primary hypothyroidism, type 2 diabetes mellitus, and peripheral neuropathy presented with a 20-year history of recurrent lipomatous formations. Enlarging lesions were previously on his upper back, posterior left ear, and bilateral shoulders. Pathology showed benign lipomas in all resections. Rapid growth of similar lesions had now occurred throughout his shoulder girdle, upper back, sternum, and submandibular regions. His quality of life had been affected, as the sternal mass caused recumbent pressure. Work-up was negative for Cushing syndrome and acromegaly. No genetic studies were performed. Family history and social history were insignificant. Given his presentation, history of recurrent benign lipomatous formations, and associated endocrinopathies, the diagnosis of Madelung disease was confirmed. As surgery is the mainstay treatment, he is following with plastic surgery for removal of his sternal mass. Conclusion: The uniqueness of this case is his severity of lipomatous enlargement, non-Mediterranean descent, and lack of alcohol abuse. As quality of life can be severely impaired, future medical treatment options should be pursued to assist those patients already through extensive surgeries.