Multiple symmetric lipomatosis (MSL) is a rare condition of the fatty tissue affecting mostly white men between 20 and 65 years old especially in the mediterranean region. The disease is characterized by a massive development of large unencapsulated lipomas mainly located on the subcutaneous tissue of the cervical, deltoid, thoracic, abdominal and lumbar areas and it is often accompanied by hyperuricemia, dyslipemia, macrocytic anaemia, peripheral neuropathy, impaired glucose tolerance and alcohol consumption. Alcohol could both promote the development of lipomas through changes in the number and function of beta-adrenergic receptors and because of its lipogenic and antilipolytic action. Other authors have hypothesized that the defective lipolysis is due to a disorder in the mitochondria of brown fat whose distribution is similar to the peculiar position of the lipomas in the MSL. In this report the authors describe an atypical clinical picture of MSL in a 65-years-old white man.