Clinical features of acquired lipodystrophy after total body irradiation: a case report and mini review.

Abstract

Background: Acquired partial lipodystrophy is a late complication of total body irradiation (TBI) performed during hematopoietic stem cell transplantation. Diagnosing this condition remains challenging due to its rarity and limited clinical awareness. Long-term patient observation is essential since this type of lipodystrophy develops more than a decade post-TBI.

Case report: We present a unique case of a patient with acquired lipodystrophy who underwent TBI for leukemia treatment in 2003 and was diagnosed with diabetes in 2013, but standard diabetes therapies proved ineffective. By 2018, the patient exhibited distinctive features, i.e. hirsutism, reduced lean mass, cutaneous alterations (including an umbilical psoriatic plaque), barrel chest, hepatomegaly, lipoatrophy of upper and lower limbs, acanthosis nigricans in the axillae and Cushingoid facies. In 2020, she was diagnosed with breast cancer, followed by liver, ovarian and pancreatic metastases in 2021.

Results: In addition to this case report, we reviewed the literature on acquired lipodystrophy cases following TBI to compare their clinical features and phenotypes with those of our patient. This comparison aims to aid clinical practice by facilitating earlier diagnosis and treatment of lipodystrophy.

Conclusion: TBI can lead to acquired lipodystrophy, which is associated with severe comorbidities. Due to its diagnostic complexity, expert clinicians and a multidisciplinary approach are essential for early identification and appropriate treatment according to etiologic aspects. We hypothesize that this condition may serve as a model for studying metabolic dysfunction in fat-related diseases.