A Patient with Congenital Generalized Lipodystrophy

Document Type : Case Report

Authors

1 Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of Gastroenterology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: Congenital generalized lipodystrophy (CGL) presents during the first two years of life. It is a rare autosomal recessive inherited disease with loss of cutaneous fat and various complaints and complications such as diabetes mellitus, hypertriglyceridaemia and hepatic steatosis.
Case Report: A patient was hospitalized with abdominal distention, weight loss, irritability, and pruritus. Massive hepatomegaly, huge splenomegaly, multiple significant lymphadenopathies, hypertrichosis, generalized subcutaneous fat loss with bird-faced, increased musculature, and prominent superficial veins were detected on examination. In paraclinical evaluation, hyperlipidemia and severe liver fibrosis (grade 5) were diagnosed, and she was discharged as a case of congenital generalized lipodystrophy.
Conclusion: In an approach to a child with hepatosplenomegaly, lipodystrophy should be in mind.

Keywords


  1. Dong G, Liang L, Zou C. Congenital generalized lipodystrophy in a 4-year-old Chinese girl. Indian Pediatr 2005; 42(10): 1036-8.
  2. Hussain I, Garg A. Lipodystrophy syndromes. Endocrinol Metab Clin North Am 2016; 45(4): 783-97.
  3. Garg A. Clinical review#: Lipodystrophies: genetic and acquired body fat disorders. J Clin Endocrinol Metab 2011; 96(11): 3313-25.
  4. Brown RJ, Gorden P. Leptin therapy in patients with lipodystrophy and syndromic insulin resistance. Berlin, Germany: Springer; 2015. p. 225-36.
  5. Hasani-Ranjbar S, Soltani A, Hadavi M, Ejtahed H-S, Mohammad-Amoli M, Radmard AR. Congenital generalized lipodystrophy in a youth presented with sclerotic and lytic bone lesions; a family with AGPAT2 mutation. Int J Pediatr 2017; 5(2): 4275-84.
  6. Guerreiro V, Bernardes I, Pereira J, Silva RP, Fernandes S, Carvalho D, et al. Acromegaly with congenital generalized lipodystrophy–two rare insulin resistance conditions in one patient: a case report. J Med Case Rep 2020; 14(1): 34.
  7. Antuna-Puente B, Boutet E, Vigouroux C, Lascols O, Slama L, Caron-Debarle M, et al. Higher adiponectin levels in patients with Berardinelli-Seip congenital lipodystrophy due to seipin as compared with 1-acylglycerol-3-phosphate-o-acyltransferase-2 deficiency. J Clin Endocrinol Metab 2010; 95(3): 1463-8.
  8. Handelsman Y, Oral EA, Bloomgarden ZT, Brown RJ, Chan JL, Einhorn D, et al. The clinical approach to the detection of lipodystrophy an aace consensus statement. Endocr Pract 2013; 19(1): 107-16.
  9. Hayashi YK, Matsuda C, Ogawa M, Goto K, Tominaga K, Mitsuhashi S, et al. Human PTRF mutations cause secondary deficiency of caveolins resulting in muscular dystrophy with generalized lipodystrophy. J Clin Invest 2009; 119(9): 2623-33.
  10. Berger JR, Oral EA, Taylor SI. Familial lipodystrophy associated with neurodegeneration and congenital cataracts. Neurology 2002; 58(1): 43-7.
  11. Misra A, Garg A. Clinical features and metabolic derangements in acquired generalized lipodystrophy: case reports and review of the literature. Medicine (Baltimore) 2003; 82(2): 129-46.
  12. Khandpur S, Kumar A, Khadgawat R. Congenital generalized lipodystrophy of Berardinelli-Seip type: A rare case. Indian J Dermatol Venereol Leprol 2011; 77(3): 402.
  13. Lee LA, Hobbs KF. Lipodystrophy and metabolic abnormalities in a case of adult dermatomyositis. J Am Acad Dermatol 2007; 57(5 Suppl): S85-7.
  14. Agarwal AK, Simha V, Oral EA, Moran SA, Gorden P, O’Rahilly S, et al. Phenotypic and genetic heterogeneity in congenital generalized lipodystrophy. J Clin Endocrinol Metab 2003; 88(10): 4840-7.
  15. Van Maldergem L, Magré J, Khallouf T, Gedde-Dahl T, Delépine M, Trygstad O, et al. Genotype-phenotype relationships in Berardinelli-Seip congenital lipodystrophy. J Med Genet 2002; 39(10): 722-33.
  16. Brown RJ, Araujo-Vilar D, Cheung PT, Dunger D, Garg A, Jack M, et al. The diagnosis and management of lipodystrophy syndromes: a multi-society practice guideline. J Clin Endocrinol Metab 2016; 101(12): 4500-11.
  17. Vázquez C, Reyes R, Alcaraz F, Balsa J, Botella-Carretero J. Eucaloric substitution of medium chain triglycerides for dietary long chain fatty acids improves body composition and lipid profile in a patient with human immunodeficiency virus lipodystrophy. Nutr Hosp 2006; 21(4): 552-5. [In Spanish].