Disclosures: Stephen Leb, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with chief complaint of worsening balance. She had Madelung’s disease, also known as symmetric lipomatosis. The cause is unknown but it is strongly associated with liver dysfunction. Over 20 years, she had redistribution of fat from her chest and hips to her upper back. She reported worsening balance over the last 3 years with marked instability when on uneven surfaces, changing directions, or performing transitional movements. The physical exam was notable for redistribution of body mass and center of gravity with soft tissue atrophy of the hip girdle and breasts and multiple soft tissue masses up to 15 cm in diameter distributed throughout the trunk. Motor exam revealed normal strength except for 4+/5 hip abduction bilaterally. Sensation to light touch and proprioception was intact. Because of body mass redistribution she had difficulty maintaining balance when not upright or when reaching outside of her base of support. She was referred to physical therapy to work on balance, gait mechanics, and transitional movements.

Setting: Outpatient General Physiatry Clinic

Patient: 64-year-old female with history of liver transplant, Madelung’s Disease, and poor balance Assessment/

Results: Over 2 weeks of physical therapy, she demonstrated improvements in berg balance and dynamic gait indices, as well as tolerance of single leg stance and tandem gait. She went from requiring maximum assistance to moderate assistance with transfers from half kneeling to standing.

Discussion: Madelung’s disease is a rare cause of fat redistribution comprising loss of fat in the limbs and accumulation of fatty masses throughout the trunk. In this case, the redistribution of body mass resulted in poor balance, postural instability and increased fall risk. Body morphology should be assessed when evaluating patient’s presenting with poor balance.

Conclusion: This case describes an unusual cause of poor balance, highlights the importance of awareness of symmetric lipomatosis, and demonstrates appropriateness of intervention.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/madelungs-disease-as-a-cause-of-poor-balance-a-case-report/