A rare presentation of lipodermatosclerosis following gastric bypass surgery: A case report

A 61-year-old female smoker with a history of severe obesity underwent gastric bypass surgery nine months ago, resulting in a 40 kg weight loss. Despite this improvement, she developed worsening pain, swelling, and edema in both legs and feet over the past three months, with no relief from compression stockings. Further examinations, including joint ultrasound and vascular assessment, ruled out arthritis, chronic venous insufficiency, and arterial issues. A dermatological biopsy and magnetic resonance imaging revealed fibrotic changes consistent with lipodermatosclerosis (LDS), a condition typically associated with venous insufficiency and subcutaneous fibrosis. Given the inflammatory nature of the symptoms, treatment with prednisolone and methotrexate was initiated, resulting in complete resolution of the symptoms within two weeks. The case highlights the importance of early recognition and appropriate treatment of LDS in patients with rapid weight loss and skin induration, and underscores the role of a multidisciplinary approach in managing complex dermatologic and rheumatologic presentations.