Recurrent stroke as a presenting feature of acquired partial lipodystrophy
A 16-year-old girl presented with a history of weakness of left upper limb and lower limb to emergency department. She had similar history of left-sided weakness 6 months back. She is a product of consanguineous marriage of healthy parents, born at term with a birth weight of 2.5 kg. There was no history of birth asphyxia or gestational diabetes in the mother. She has one younger brother aged 6 years and was reported to be healthy. There was no history of similar cases in the family. There was progressive loss of facial fat for the last 3 years [].\nThe child was diagnosed primary hypothyroidism 10 months back on thyroxine (100 μg/day) replacement. She has been diagnosed as type 2 diabetes mellitus 3 months back on oral hypoglycemic agents (glimepiride, 2 mg; metformin, 1,000 mg; and pioglitazone, 30 mg) with moderate glycemic control. There was history of lethargy and daytime sleepiness. There was history of operation for bilateral cataract at the age of 8 years. She had attained menarche at the age of 13 years and the periods are regular.\nPhysical examination showed marked symmetrical atrophy of fat over face, neck, shoulders, arms, and forearms and that extends to the thoracic region and upper abdomen. Muscular prominence is noticed in the above areas. Lower abdomen, pelvic girdle, and lower limbs were spared. Acanthosis nigricans and diffuse thyromegaly were noted. There was weakness of left upper and lower limbs. There was no facial muscle weakness.\nHer weight was 54 kg (25-50th percentile) and height was 159 cm (50-75th percentile). The clinical assessment of cardiovascular and respiratory system was normal. There was no hepatosplenomegaly. The biochemical and laboratory details are presented in .\nAdolescent onset progressive loss of subcutaneous fat over the face and associated autoimmune diseases such as SLE, anticardiolipin antibody, primary hypothyroidism, and diabetes complicating cerebrovascular accident with recurrent left hemiparesis suggests the diagnosis of acquired PL. The girl was started on antiplatelet agents, statins, 2 mg coumarin, 100 μg thyroxine, 1,000 mg metformin, and 15 mg pioglitazone