Images in Clinical Medicine

Buffalo Hump in a Patient with the Acquired Immunodeficiency Syndrome

David M. Aboulafia, M.D., and Denise Bundow, A.R.N.P.

N Engl J Med 1998; 339:1297October 29, 1998

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Figure 1 A 52-year-old man infected with the human immunodeficiency virus (HIV) was treated with zidovudine and lamivudine when his CD4+ lymphocyte count dropped to 105 cells per cubic millimeter and the viral load was 225,000 copies of HIV RNA per milliliter. This treatment was continued for 15 months, but when the viral load tripled, the regimen was changed to highly active antiretroviral therapy consisting of two nucleoside analogues (stavudine and lamivudine) and an HIV-protease inhibitor (indinavir). Within six weeks after the initiation of therapy, the viral load fell to less than 500 copies per milliliter. One year later, the patient began to have difficulty buttoning the topmost button of his shirt. The results of an examination were unremarkable except for a painless, nontender cervicodorsal fat pad that measured 16 cm by 14 cm (Panel A). Computed tomographic scans of the cervical region further defined the large and symmetric subcutaneous deposit of adipose tissue (Panels B and C). No abnormalities in endocrine function or lipid metabolism were detected, the CD4+ count was 360 cells per cubic millimeter, and the level of HIV RNA was less than 500 copies per milliliter. The buffalo hump continues to enlarge, and the patient is sufficiently concerned about his appearance to contemplate surgical removal of the hump. He is still receiving highly active antiretroviral therapy.

David M. Aboulafia, M.D.
Denise Bundow, A.R.N.P.
Virginia Mason Clinic, Seattle, WA 98111

Citing Articles (12)

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