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A 43-year-old lady was detected to have diabetes mellitus at the age of 30 years on
the basis of weight loss, osmotic symptoms and random venous plasma glucose of
280 mg/dL. She was put on medical nutrition therapy and oral anti-diabetic agents
for initial 5 years, and subsequently was put on two doses of premixed 30:70 insulin 5
units twice daily. Fasting plasma glucose would remain around 140–160 mg% and
two-hour post-prandial around 200 mg%. She had gradually noticed swellings around
neck and front of chest more on right side. She also had noticed difficulty in
breathing. She was nonalcoholic and had no apparent chronic complications of
diabetes mellitus. She had family history of diabetes mellitus in father and two
siblings. She was menstruating regularly. Examination revealed height 149 cm,
weight 47 kg with BMI of 21.17 kg/M2, blood pressure was 124/100 mmHg spine. She
had diffuse swelling around the front of neck giving the appearance of “double chin”.
In addition she also had diffuse swellings in supraclavicular, deltoid areas and front of
the chest (Fig. 1). She also had thickened lower lip and macroglossia with teeth marks
over it. Examination of nervous system revealed absent bilateral ankle and knee
jerks. Fundus examination revealed bilateral non-proliferative retinopathy. Rest of
the systemic examination was normal. Autonomic function revealed loss of
parasympathetic and normal sympathetic activity. Investigations revealed normal
complete blood count with ESR of 50 mm/hr, routine tests for liver and kidney
How to cite this article: functions were normal as was serum calcium and phosphorus. Serum lipids revealed
Memon S, Sriwastava M, total cholesterol of 199 mg/dL, low-density lipoprotein of 120 mg/dL, high density
Khanna R et al.Multiple lipoprotein of 47 mg/dL, triglycerides of 164 mg/dL and very-low-density lipoprotein
Symmetrical Lipomatosis
of 32 mg/dL. Serum uric acid was 2.4 mg/dL, Thyroid function and 8 AM cortisol was
with Involvement of Tongue.
J Adv Res Med 2016; 3(2&3): normal. Computed tomography revealed lipomatosis of neck, upper chest, without
8-10. any evidence of mediastinal extension. Biopsy was consistent with lipomatosis. A
diagnosis of multiple systemic lipomatosis (Madelung diseases) with macroglossia
ISSN: 2349-7181 was made and patient was put on insulin and oral anti-diabetic agents. Metabolic
control was achieved and patient was planned for excision of lump in front of neck
but did not follow.
Figure 1.Symmetrical Fat Deposit in Lower Lip, Submental Area, Neck, Supraclavicular,
Deltoid and Upper Chest (Arrows)
In summary, the present case description is that of a in women. To our knowledge, this is the first such case
young lady with multiple symmetrical lipomatosis with reported from India.
involvement of lower lip and tongue, who also had
diabetes mellitus and hyperlipidemia. The case scenario Conflict of Interest: None
is interesting in view of rarity of the disorder, especially
9 ISSN: 2349-7181
Memon S et al. J. Adv. Res. Med. 2016; 3(2&3)
ISSN: 2349-7181 10