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JAMA Clinical Challenge

A 51-Year-Old Man With HIV and Cervicodorsal Lipodystrophy (Buffalo Hump)

Image of lipodystrophy in the cervicodorsal fat pad

Sachin M. Shridharani, MD
Raja Mohan, MD
A 51-year-old African American man with a history of human immunodeficiency virus (HIV) and taking abacavir/lamivudine/zidovudine for 1 year presents to the plastic surgery clinic with a chief complaint of cervical lipodystrophy. The patient's only comorbid condition is hypertension, which is being treated with a β-blocker. Physical examination reveals lipodystrophy in the cervicodorsal fat pad (nape of neck) (Figure). No lipodystrophy is noted in any other anatomical region. Laboratory measures include complete blood cell count, complete metabolic panel, and full endocrine panel; findings are normal. Dexamethasone suppression test results and 24-hour urinary cortisol level are also normal. The patient's CD4 cell count at the time of presentation is 556 cells/μL, and viral load had reached undetectable levels after 1 year of antiretroviral therapy.

See the full article for an explanation and discussion.

Author Affiliations: Drs Shridharani (sachin_shridharani@hotmail.com) and Mohan are affiliated with the Department of Plastic Surgery, The Johns Hopkins University; and Department of Plastic Surgery, The Johns Hopkins Hospital Outpatient Center, Baltimore, Maryland.