68 year old female with a history of rheumatoid arthritis and systemic lupus presented with the right upper quadrant abdominal pain due to acute cholecystitis. The patient was on chronic steroid (Prednisone) therapy for RA and SLE.

Chronic use of steroids is associated with multiple adverse effects. Multiple organs and systems could be affected. The image above demonstrates an example of truncal obesity and cushingoid appearance which are very common with chronic use of steroid. Truncal obesity means primarily central fat distribution around the torso and abdomen rather than extremities.

The patient had a very complicated hospital stay suffering from respiratory and kidney failure. It has been shown that the patients with primarily truncal obesity have a higher mortality in ICU compared to the patients with just an elevated BMI.