John T. Schindler, MD; Katherine M. Spooner, MD; Catherine F. Decker, MD
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Schindler JT, Spooner KM, Decker CF. “Buffalo Humps” Associated with Protease Inhibitors. Ann Intern Med. 1998;129:164. doi: 10.7326/0003-4819-129-2-199807150-00032
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Published: Ann Intern Med. 1998;129(2):164.
TO THE EDITOR:
Since the inception of protease inhibitors, unusual side effects resulting in body habitus changes have been seen with the use of indinavir (breast hypertrophy)  and ritonavir (abdominal girth) . We recently cared for three patients who presented with the rapid onset of increasing cervicodorsal tissue (“buffalo humps”) while receiving protease inhibitors.
Table 1 shows the characteristics of these patients. The average size of the cervicodorsal enlargement was 14 × 14 cm. None of the patients had signs of hypercortisolism or a history of steroid use. Findings on evaluation for Cushing disease were negative. Deep punch biopsies revealed increased collagen deposition replacing the periadnexal loose connective tissue in the dermal region, suggesting a scleroderma-like reaction.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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