{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T06:11:50Z","timestamp":1696313510244},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2014,6,5]],"date-time":"2014-06-05T00:00:00Z","timestamp":1401926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Obesity"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>A 51\u2010year\u2010old man was referred for evaluation of gradual increase in body fat over bilateral arms, chest and abdomen for 6\u2009months. He was a non\u2010smoker and he drank at least four bottles of beer daily since the age of 18. There was no significant past medical history or any family history of obesity or endocrine diseases. Physical examination showed localized large bulk of fat over the neck, both arms and mammary regions, abdomen, and back (Figs\u2009<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#cob12061-fig-0001\" \/> and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#cob12061-fig-0002\" \/>). The lower limbs and buttock were relatively spared. There was telangiectasia over the face and chest wall, but no palmar erythema nor finger clubbing. The liver span was normal, and the spleen tip was palpated 2\u2009cm below the costal margin. Examination of the cardiovascular, respiratory and neurological system was normal.<\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Localized large bulk of fat over both arms, mammary regions and abdomen.<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/cob12061-fig-0001-m.png\"><jats:alt-text>figure<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Localized large bulk of fat over mammary regions and abdomen.<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/cob12061-fig-0002-m.png\"><jats:alt-text>figure<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p>Blood tests showed thrombocytopenia (platelet 140\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\u2009L<jats:sup>\u22121<\/jats:sup> [normal: 170\u2013380\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\u2009L<jats:sup>\u22121<\/jats:sup>]) and liver function derangement (bilirubin 27\u2009\u03bcmol\u2009L<jats:sup>\u22121<\/jats:sup>, <jats:styled-content style=\"fixed-case\">ALP<\/jats:styled-content> 298\u2009U\u2009L<jats:sup>\u22121<\/jats:sup>, <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> 127\u2009U\u2009L<jats:sup>\u22121<\/jats:sup>, <jats:styled-content style=\"fixed-case\">AST<\/jats:styled-content> 165\u2009U\u2009L<jats:sup>\u22121<\/jats:sup>, <jats:styled-content style=\"fixed-case\">GGT<\/jats:styled-content> 1353\u2009U\u2009L<jats:sup>\u22121<\/jats:sup>, albumin 33\u2009g\u2009L<jats:sup>\u22121<\/jats:sup> and globulin 42\u2009g\u2009L<jats:sup>\u22121<\/jats:sup>). His clotting profile and renal functions were normal. His hepatitis <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content> surface antigen was positive, but his <jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content> was &lt;60\u2009copies per mL. Fasting glucose was 5.0\u2009mmol\u2009L<jats:sup>\u22121<\/jats:sup>. <jats:styled-content style=\"fixed-case\">HbA<\/jats:styled-content>1c was 5.6%. His lipid profile was satisfactory with total cholesterol of 2.9\u2009mmol\u2009L<jats:sup>\u22121<\/jats:sup>, triglycerides 1.0\u2009mmol\u2009L<jats:sup>\u22121<\/jats:sup>, <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content> 1.37\u2009mmol\u2009L<jats:sup>\u22121<\/jats:sup> and <jats:styled-content style=\"fixed-case\">LDL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content> 1.1\u2009mmol\u2009L<jats:sup>\u22121<\/jats:sup>. Ultrasound of the abdomen showed normal\u2010sized liver with coarsened liver parenchymal echogenicity. The spleen was enlarged to 14\u2009cm.<\/jats:p><jats:p>This middle\u2010aged man suffered from multiple symmetric lipomatosis and alcoholic liver disease. Dual\u2010energy <jats:styled-content style=\"fixed-case\">X<\/jats:styled-content>\u2010ray showed 1746\u2009gm (40.1%), 1498\u2009gm (32.8%) and 8322\u2009gm (26.8%) fat over the left arm, right arm and trunk, respectively. The legs were unaffected with 1703\u2009gm (19.4%) and 1627\u2009gm (17.7%) fat over the left and right sides, respectively. The patient was advised to stop drinking and he declined surgical treatment.<\/jats:p>","DOI":"10.1111\/cob.12061","type":"journal-article","created":{"date-parts":[[2014,6,5]],"date-time":"2014-06-05T11:18:47Z","timestamp":1401967127000},"page":"237-240","source":"Crossref","is-referenced-by-count":0,"title":["A middle\u2010aged man with increasing body fat"],"prefix":"10.1111","volume":"4","author":[{"given":"J. K. Y.","family":"Lam","sequence":"first","affiliation":[{"name":"Department of Medicine Queen Mary Hospital  Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. S. L.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary Hospital  Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. S.","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary Hospital  Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. C. 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