Benign symmetrical lipomatosis associated with alcoholism

Dear Editor, Benign symmetrical lipomatosis is a rare disorder characterized by fat distribution in the shoulders, arms and neck in the context of chronic alcoholism. Over a period of years, the fat deposits grow to a large size, become cosmetically deforming and, in advanced cases, cause dyspnea. A 42-year-old man presented with multiple, large, symmetrical masses in his neck, shoulders and upper arms that had enlarged progressively for the previous 4 years (Fig. 1). The patient complained of discomfort and a deteriorating range of neck motion. Moreover, he complained of difficulty finding clothes that fit his neck and shoulders. Subcutaneous veins around the neck were remarkably distended up. Magnetic resonance imaging confirmed the presence of large masses of subcutaneous fat tissue infiltrating the surrounding tissue (Fig. 2). Biopsy showed lipomas histologically. Routine laboratory blood tests including electrolytes, glucose and a complete blood count were within normal limits. Abdominal echography showed no additional information such as fatty liver or liver cirrhosis. His past history was unremarkable, although he had been a heavy drinker for 20 years. According to these clinical findings, our patient was diagnosed with benign symmetrical lipomatosis. At first, we advised him to avoid drinking, although abstinence from alcohol does not reverse the progression of the disease. Surgical excision was performed bilaterally at the shoulders. However, it was difficult to remove all of the lesions because the external jugular vein and some nerves were located in proximity to these lesions. Benign symmetrical lipomatosis is characterized by diffuse deposits of fat arranged symmetrically around the neck, shoulders and upper extremities. It is more frequent in middle-aged men who have a history of decades of heavy alcohol consumption. This condition is also known as Madelung disease. This uncommon disease predominantly affects men between the ages of 30 and 60 years. It is assumed to be a discrete malfunction in fat metabolism