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[Ischemic ulcer in Madelung disease].

T Nowakowski¹, J Bartlewicz, R Nizankowski

¹II Katedra Chorób Wewnetrznych CMUJ w Krakowie.

Polskie Archiwum Medycyny Wewnetrznej

|March 10, 2001

Summary

Madelung disease, a rare condition causing lipomas, can lead to peripheral artery disease and foot ulcers. Surgical intervention improved symptoms in a patient with this rare condition.

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Area of Science:

Vascular Surgery
Endocrinology
Dermatology

Background:

Madelung disease, characterized by excessive adipose tissue accumulation, is often associated with metabolic abnormalities.
Peripheral artery disease (PAD) can manifest with atypical symptoms, complicating diagnosis and treatment.
Intermittent claudication and chronic ulceration are significant complications that can arise from PAD.

Observation:

A 50-year-old male with Madelung disease presented with a two-year history of intermittent claudication and a persistent, painless left foot ulcer.
The patient's lipomata were extensive, located on the neck, shoulders, and chest, and had progressively enlarged.
Initial assessment of the foot ulcer suggested an uncertain ischemic origin due to its atypical presentation and a normal ankle-brachial index (>0.5).

Findings:

Despite conservative management with alprostadil infusions, the foot ulcer showed poor response and progressive enlargement.
Angiographic examination revealed findings amenable to surgical intervention.
Aorto-bifemoral prosthesis implantation resulted in satisfactory short-term improvement of the ulceration and associated symptoms.

Implications:

This case highlights the potential association between Madelung disease and peripheral artery disease, necessitating thorough vascular assessment.
Atypical presentations of ischemic foot ulcers require a high index of suspicion and comprehensive diagnostic workup.
Surgical revascularization can be a viable option for managing severe ischemic complications in patients with Madelung disease and PAD.

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