Hyperlipidemic Nodules

A 56-year-old man was admitted to the hospital with right lower lobe pneumonia, which was exacerbated by smoking-induced chronic obstructive pulmonary disease (COPD).

The patient's hydration status was good. The examination and chest film revealed evidence of right lower lobe consolidation. His pulse rate was 100 beats per minute; temperature, 38.2°C (100.8°F); and respiration rate, 30 breaths per minute. The laboratory work-up yielded the following levels: total triglycerides, 1,800 mg/dL; total cholesterol, 860 mg/dL; high-density lipoprotein, 55 mg/dL; and low-density lipoprotein, 240 mg/dL.

Dr Navin M. Amin of Bakersfield, Calif, observed very firm, nontender nodules overlying the tendons of both hands and the anterior shins of both legs. The patient reported that many members of his family, including his father and three brothers, had similar lumps. His father died at age 48, and a brother died at age 44-both of acute myocardial infarction. The physical and laboratory findings combined with the family history led to the diagnosis of familial hyperlipidemia. The nodules on the extremities were xanthomas typical of this condition.

The patient's acute COPD exacerbation secondary to pneumonia responded promptly to intravenous antibiotics, intravenous corticosteroids, oxygen, and breathing treatments. Further evaluation revealed that the ECG showed nonspecific T-wave changes. A stress test was positive, and an angiogram revealed three diseased vessels. The patient underwent triple bypass surgery. A statin was prescribed for the hyperlipidemia.