[Ischemic ulcer in Madelung disease].

We describe a 50 years old man with multiple symmetric lipomatosis (Madelung disease) and two years history of intermittent claudication who was hospitalized because of persistent ulcer of left foot. Lipomata were located on the neck, shoulders and chest; they enlarged gradually over a few years, becoming huge in size. Ulceration of the foot appeared a few weeks before hospitalization and its ischaemic origin was uncertain because of atypical character (painless, ankle/brachial index > 0.5). After angiographic examination patient was assigned for conservative treatment. Intravenous infusions of alprostadil were given with poor effect. Because of gradual enlargement of the ulceration, pain intensification and relatively favourable angiographic picture aorto-bifemoral prosthesis implantation was performed with satisfactory short-therm effect. In addition, patient required vitamin B12 supplementation due to megalocytic anemia.