DOI: https://doi.org/10.36347/sjmcr.2026.v14i07.023

Pages: 1708-1712

Lipedema is a chronic, underdiagnosed disorder of adipose tissue that almost exclusively affects women and is characterized by painful, disproportionate fat accumulation in the limbs. Bariatric surgery, although effective for weight loss, does not consistently improve lipedema and may promote deficiency-related neurological complications. We report the case of a 27-year-old woman who presented, four months after sleeve gastrectomy for morbid obesity (preoperative BMI 42 kg/m²), with bilateral lower-limb edema, distal cyanosis, and neuropathic pain, in a context of irregular postoperative follow-up and poor adherence to supplementation. Examination revealed typical lipedema and a distal “sock-and-glove” sensory deficit. Electroneuromyography demonstrated a length-dependent axonal polyneuropathy, and laboratory testing revealed folate deficiency. A multidisciplinary strategy was implemented: neuropathic pain management (pregabalin, low-dose amitriptyline), correction of deficiencies (folate and a reinforced bariatric multivitamin supplement), and conservative treatment of lipedema (compression and manual lymphatic drainage). At three months, the edema, skin color, and neurological symptoms had markedly improved. This case highlights that lipedema may persist or be unmasked after bariatric surgery and that inadequate nutritional follow-up exposes patients to deficiency-related axonal polyneuropathies, particularly from folate deficiency. Structured, lifelong multidisciplinary monitoring is essential.