An intellectually normal 18-year-old man presented with a history of decreased bulk on the left side, including his chest, arm, and leg, apparent since the age of 12 years (Fig. 1). His early childhood health and development had been uneventful except for a dry, erythematous rash of his upper left leg at the age of 8 years. He sought a medical opinion about the underdevelopment of his left chest wall at the age of 14 years; initially, right-sided gynecomastia was diagnosed as the cause of the asymmetric fat distribution. As the disease progressed, he was investigated for a neurogenic cause of hemiatrophy, but cranial MRI, electromyography and nerve conduction velocity of his upper left limb were normal. Ultrasono-graphy of his viscera showed no organomegaly and no malformations. The family history was significant for a paternal uncle with one leg smaller than the other, but it was not possible to collect further history or to examine him. The patient's father had suffered a premature myocardial infarction, with underlying tobacco smoking and dyslipidemia as risk factors.
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