The patient stated these were painless and had gradually grown in size since their appearance about 15 years ago. He had undergone a neck CT scan and subsequent biopsy of these lesions in the past which had confirmed that they were benign lipomas. He was therefore diagnosed with benign symmetrical lipomatosis. This disorder, which has also been called Madelung's syndrome, Launois-Bensuade syndrome, or multiple symmetrical lipomatosis, is characterized by multiple large symmetrical lipomas around the neck and upper chest. The underlying pathophysiology of this disorder is unclear, but an association with chronic alcohol abuse has been well described.
Surgical therapy is indicated for cosmetic reasons only, and the lipomas almost always recur.
This Image of Osler shows benign symmetrical lipomatosis. Laboratory analysis of the ascitic fluid revealed several thousands polymorphonuclear neutrophils with gram-negative coccobacilli seen on gram stain. Cultures of the ascitic fluid and of blood later grew Pasteurella multocida . According to published case reports, cloudy orange fluid, as seen in this case, is characteristic of Pasteurella spontaneous bacterial peritonitis. The organism is usually sensitive to penicillin and cephalosporins as well as fluoroquinolones which may be used for spontaneous bacterial peritonitis prophylaxis.