[Benign symmetrical lipomatosis ("peripheral lipodystrophy") during antiretroviral therapy of HIV infection].
METHODS
A 29-year-old hemophiliac with HIV infection for which he was receiving antiretroviral treatment (ART) with indinavir, zidovudine and zalcitabine reported increasing swelling of the neck. Physical examination noted a soft to doughy swelling, not sensitive to pressure, extending from the neck to between the shoulder blades.


METHODS
Ultrasonography and magnetic resonance imaging revealed the swelling to consist of an accumulation of subcutaneous fat without capsule. Cytology demonstrated benign fatty tissue. Blood triglycerides totalled 667 mg/dl.


METHODS
The typical location, absence of a capsule and the cytological finding confirmed the clinical diagnosis of drug-induced benign symmetrical lipomatosis (BSL, also called peripheral lipodystrophy) in ART. A connection with the hyperlipoproteinaemia is supported by the observation that the patient used to have a normal fat metabolism; the onset of BSL coincided with a massive increase in triglyceride levels. The hyperglyceridaemia and clinical signs improved on a low-fat diet.


CONCLUSIONS
BSL can occur in the course of ART in HIV infection, when reverse-transcriptase inhibitors or protease inhibitors are being taken. Medication should not be changed, when antiretroviral treatment is adequate. To reduce the symptoms low-fat diet should be tried, as well as administration of HMG-CoA-reductase inhibitors or, if necessary, surgical liposuction.
Fischer
T
T
Abteilung Gastroenterologie und Endokrinologie, Medizinischen Klinik der Universität Göttingen.
Schwörer
H
H
Ramadori
G
G
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000209:etiology; D006467:Hemophilia A / Q000150:complications; D006801:Humans; D019469:Indinavir / Q000009:adverse effects / Q000627:therapeutic use; D008069:Lipomatosis, Multiple Symmetrical / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D016047:Zalcitabine / Q000009:adverse effects / Q000627:therapeutic use; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine; D019469:Indinavir; D016047:Zalcitabine