Lipomatosis From Prolonged Use of Corticosteroids in Ethiopia: A Case Report

Lipomatosis is characterized by abnormal, localized fat overgrowth without associated fat loss. These growths are typically benign and follow specific distribution patterns. When induced by corticosteroids, this fat hypertrophy can occur in various locations, most commonly in the spinal epidural, retro-orbital, and mediastinal spaces. Computed tomography and magnetic resonance imaging are the most effective diagnostic tools. While stopping or reducing corticosteroid therapy can lead to the shrinking or disappearance of these deposits, this outcome is not always consistent. A 52-year-old Black African male from a rural area, with a history of asthma, presented to the Mechare Clinic in Woldia, Ethiopia, reporting two months of intensifying back pain. The patient had been self-managing his symptoms for approximately 15 years using diclofenac, prednisolone, and dexamethasone injections obtained without a medical prescription. Clinical examination revealed characteristic signs of steroid excess, including facial puffiness, a dorsocervical fat pad (buffalo hump), and central obesity (waist circumference of 120 cm). Respiratory assessment showed scattered wheezing and bronchial breath sounds at the left posterior lung base. Diagnostic investigations confirmed leukocytosis, impaired fasting glucose, and vitamin D deficiency. Imaging studies further identified left lower lung consolidation, systemic osteoporosis, multiple rib and vertebral fractures, and diffuse and extensive lipomatosis involving the pleural, pericardial, and mediastinal regions. The therapeutic advantages of corticosteroids must be carefully weighed against the risk of serious side effects. Clinicians should provide close supervision during long-term therapy to ensure that the cumulative risks do not outweigh the clinical benefits. Furthermore, educating patients on the safe and proper use of these medications is essential for minimizing harm.