Lymphadenopathy associated with severe hypertriglyceridemia

Article Abstract:

Lymphadenopathy is the condition of enlarged lymph nodes which can occur locally in response to an infection or systemically in response to various disease states. To rule out a serious disease process, it is especially important to determine the cause of generalized lymphadenopathy. This case describes a 47-year-old insulin-dependent diabetic woman who had generalized lymphadenopathy as a manifestation of type V hyperlipidemia, an excess of triglycerides and chylomicrons (small fat particles found in the blood after eating fat). From the age of 18 this patient had a history of enlarged lymph nodes under her arms (axillary nodes), and a physical exam at age 35 noted large, palpable axillary lymph nodes. Subsequently, she was admitted to the hospital with abdominal pain, severe hypertriglyceridemia (high triglycerides in the blood), and diabetes mellitus. She had palpable parotid and submandibular salivary glands, as well as enlarged cervical, axillary, supraclavicular and inguinal lymph nodes. Other abnormal findings included tenderness in the abdominal area, and neurologic deficits in the lower extremities. Lab tests revealed a microcytic (small red blood cells) anemia. There was a history of several hospitalizations for symptoms of uncontrolled diabetes. The patient had been treated with antihypertensive medication and insulin, but not lipid-lowering drugs. Her family history revealed one of seven sisters with diabetes mellitus, but no lipid abnormalities. The possible causes for her lymphadenopathy included lymphoma (tumor in lymphatic system) and chronic infection. A biopsy reported that an axillary lymph node was almost entirely fatty tissue. A second lymph node was biopsied two months later with similar findings. She was discharged from the hospital with a diagnosis of type V hyperlipidemia and given dietary guidelines to help reduce the lipid levels. The patient was able to lower her triglyceride level over the following year with the dietary changes, and her lymphadenopathy completely resolved. Since then whenever her triglyceride level increases due to poor compliance to treatment, her lymphadenopathy returns. By ruling out other possibilities and watching the patient over a seven-year period, it was concluded that her lymphadenopathy was due to phagocytic uptake of fat particles into her lymph cells. This case reveals the need to consider hyperlipidemia as a cause of lymphadenopathy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Complications and side effects, Type 1 diabetes, Lymphadenopathy

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Treatment choices for hypertriglyceridemia

Article Abstract:

People with slightly increased blood cholesterol levels and mild hypertriglyceridemia (increased levels of triglycerides, another type of circulating fat) are at increased risk for coronary artery disease, disease of the vessels that supply blood to the heart. They are generally advised, as a first treatment approach, to eat a low-fat, high-fiber diet and to exercise. If diet, with its advantages of low cost and safety, does not work, patients may be started on medication. A report in the December 5, 1990 issue of The Journal of the American Medical Association describes the effects of treating overweight patients who had mild hypertriglyceridemia and borderline elevated cholesterol levels with two drugs, lovastatin and gemfibrozil. The authors concluded that lovastatin was the better agent; however, questions regarding the relevance of the study's results to real life can be raised. Patients received a dose of lovastatin, an expensive agent, that was twice as large as the standard recommended dose, but received the usual dose of gemfibrozil. They were instructed to maintain their body weights (even though they were overweight, and would normally be told to reduce) during the study. Moreover, patients in clinical practice are advised to eat a low-fat diet and to exercise, but the study subjects were told to eat a diet high in saturated fat and total fat (the typical American diet). Previous studies suggest that gemfibrozil may in fact be the more effective drug, and it is known that lovastatin should not be taken by people with severe hypertriglyceridemia. Finally, these drugs should be used sparingly and appropriately, only after diet, weight loss and exercise have been tried. (Consumer Summary produced by Reliance Medical Information, Inc.)

Coronary heart disease, Diet therapy, Lovastatin

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The hypolipidemic effects of gemfibrozil in type V hyperlipidemia: a double-blind, crossover study

Article Abstract:

Two consecutive eight-week trials were performed on 13 patients to determine the effectiveness of gemfibrozil on reducing type V hyperlipidemia. This condition, genetic in origin, is characterized by high levels of plasma triglycerides which result from high concentrations of very low-density lipoproteins and chylomicrons (cholesterol-rich lipid particles from dietary fat). Four weeks prior to the trial, a low-fat diet was given to the subjects. Each patient was then given gemfibrozil or a placebo. When results were compared, patients receiving gemfibrozil had significant reductions in total plasma triglycerides, total plasma cholesterol and very low-density lipoprotein cholesterol levels. In addition, levels of chylomicrons (sphericals of fat transported in blood) in the blood serum were almost completely eliminated. A few side effects were exhibited such as mild intestinal discomfort but, in general, gemfibrozil was well tolerated. Researchers concluded that the use of gemfibrozil in the treatment of individuals with severe hyperlipidemia, along with the maintenance of a low-fat diet, was very effective in reducing excessive blood lipids. Gemfibrozil was recommended for use as a primary treatment for these patients who are at high risk for such complications as pancreatitis and atherosclerosis.

Care and treatment, Hyperlipidemia, Antilipemic agents

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