Severe form of lipoedema and obesity, therapeutic challenge: report of a rare case

Objective Lipoedema is a systemic disease with disssarenged accumulation and distribution of fat tissue, due to disturbed fat metabolism. It was first introduced as a separate clinical entity in the United States in 1940. The cause is unknown, but is bealieved genetic factors to be involved. Mostly clinically misdiagnosed, it presents as lipoedema, lipolymphedema, or combined with obesity. Case We present a case of a 42-year-old woman introduced in the endocrinology department due to overweight with a BMI of 93.6kg/m2 and disproportionate accumulation on fat tissue on both legs. It was reported present parental and twin sister obesity. All efforts for hygiene-dietary modalities were insufficient. According to the clinical findings, it is combined type 2 and 3 of lobular lipoedema in stage IV, with obesity and comorbidities. Treatment with lowcalorie diet, medicines and bariatric surgery was implemented. After that therapeutic and reconstructive plastic surgery was approached. Due to a weight regain, GLP1-RA was started, resulting with reduction of body weight. The overall treatment resulted with a weight loss of 91kg and a significant improvement health condition and quality of life. Conclusion The etiology and pathophysiology of lipedema remain unclear. The case at hand shows that there are huge therapeutic challenges for such a complex case. We show that this kind of multidisciplinary approach is necessary and it was effective, improved the quality of life and prevented comorbidities. Key words Lipoedema stage 4, obesity, Bariatric surgery, plastic surgery, GLP1-RA.