A middle-aged man with increasing body fat.

Area of Science:

• Endocrinology
• Hepatology
• Medical Imaging

Background:

• A 51-year-old man presented with a six-month history of progressive fat accumulation in his arms, chest, and abdomen.
• He reported significant daily alcohol consumption and had no prior history of obesity or endocrine disorders.

Observation:

• Physical examination revealed localized fat deposits on the neck, arms, mammary regions, abdomen, and back, with relative sparing of the lower limbs.
• Laboratory tests indicated thrombocytopenia and deranged liver function tests, including elevated bilirubin, ALP, ALT, AST, and GGT.
• Abdominal ultrasound showed a normal-sized liver with coarse echogenicity and splenomegaly.

Findings:

• The patient was diagnosed with multiple symmetric lipomatosis and alcoholic liver disease.
• Dual-energy X-ray absorptiometry (DXA) quantified significant fat content in the upper body and trunk, with unaffected lower limbs.
• Hepatitis B surface antigen was positive, but HBV DNA levels were undetectable, suggesting chronic but inactive infection.

Implications:

• This case underscores the importance of a thorough clinical evaluation for patients presenting with atypical fat distribution.
• The co-occurrence of multiple symmetric lipomatosis and alcoholic liver disease highlights potential diagnostic challenges and the need for comprehensive assessment.
• Management strategies should address both the lipomatosis and the underlying alcoholic liver disease, including lifestyle modifications such as alcohol cessation.