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JAMA Clinical Challenge
Clinician's Corner
March 27, 2013

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

Author Affiliations

JAMA Clinical Challenge Section Editor: Huan J. Chang, MD, Contributing Editor. We encourage authors to submit papers for consideration as a JAMA Clinical Challenge. Please contact Dr Chang at

Author Affiliations: Department of Plastic Surgery, The Johns Hopkins University; and Department of Plastic Surgery, The Johns Hopkins Hospital Outpatient Center, Baltimore, Maryland.

JAMA. 2013;309(12):1289-1290. doi:10.1001/jama.2013.2552

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 1). 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.

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