title: Fitting the pieces of the puzzle together: a case report of the Dunnigan-type of familial partial lipodystrophy in the adolescent girl.
abstract: BACKGROUND
  Familial partial lipodystrophy of the Dunnigan type (FPLD 2) is a rare autosomal dominant disorder caused by the mutations of the lamin A/C gene leading to the defective adipogenesis, premature death of adipocytes and lipotoxicity. FPLD 2 is characterized by a progressive loss of subcutaneous adipose tissue in the limbs and trunk, and accumulation of body fat in the face and neck with accompanying severe metabolic derangements including insulin resistance, glucose intolerance, diabetes, dyslipidemia, steatohepatitis. Clinical presentation of FPLD 2 can often lead to misdiagnosis with metabolic syndrome, type 2 diabetes or Cushing syndrome.
  
  
  METHODS
  We report a case of a 14-year-old girl admitted to the Department of Paediatrics due to chronic hypertransaminasemia. On physical examination the girl appeared to have athletic posture. She demonstrated the absence of subcutaneous adipose tissue in the extremities, sparing the face, neck and gluteal area, pseudo-hypertrophy of calves, prominent peripheral veins of limbs, massive acanthosis nigricans around the neck, in axillary and inguinal regions and natural skin folds, hepatosplenomegaly. Laboratory results revealed hypertransaminasemia, elevated γ-glutamyltranspeptydase, and dyslipidemia, hyperinsulinaemia with insulin resistance, impaired glucose tolerance, and hyperuricemia. Diffuse steatoheptitis in the liver biopsy was stated. Clinical suspicion of FPLD 2 was confirmed genetically. The pathogenic mutation, R482W (p.Arg482Trp), responsible for the FPLD 2 phenotype was identified in one allele of the LMNA gene.
  
  
  CONCLUSIONS
  Presented case highlights the importance of the holistic approach to a patient and the need of accomplished collaboration between paediatricians and geneticists. FPLD 2 should be considered in the differential diagnosis of diabetes, dyslipidemia, steatohepatitis, acanthosis nigricans and polycystic ovary syndrome.
authors.affiliation: Department of Paediatrics, Medical University of Lublin, Racławickie 1, 20-059, Lublin, Poland. paulina.krawiec@wp.pl.
authors.forename: Paulina
authors.initials: P
authors.lastname: Krawiec
authors.affiliation: Department of Paediatrics, Medical University of Lublin, Racławickie 1, 20-059, Lublin, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Mełges
authors.affiliation: Department of Paediatrics, Medical University of Lublin, Racławickie 1, 20-059, Lublin, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Pac-Kożuchowska
authors.affiliation: Department of Paediatrics, Medical University of Lublin, Racławickie 1, 20-059, Lublin, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Mroczkowska-Juchkiewicz
authors.affiliation: MEDGEN Medical Center, Orzycka 27, 02-695, Warsaw, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Czerska
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D052496:Lipodystrophy, Familial Partial / Q000175:diagnosis*
keywords: Familial partial lipodystrophy; LMNA gene; steatohepatittis