generalized lipodystrophies are a group of rare genetically heterogeneous disorders characterized by an almost absence of body fat. These disorders are also associated with dyslipidemia and insulin resistance. Congenital Generalized Lipodystrophy Type 4, also known as CGL4 is a newly identified extremely rare form of CGL. Like the classic forms, CGL4 is also associated with a marked lack of body fat, hirsutism, characteristics of insulin resistance, and muscular hypertrophy. However, these symptoms are more widespread. In addition, patients with CGL4 also show more advanced myopathy, smooth and skeletal muscle hypertrophy, cardiac arrhythmias, osteopenia, and distal metaphyseal deformation with joint stiffness. In addition, affected patients have large and weak muscles that show an involuntary rolling contraction called rippling. The cardiac arrhythmias can be fatal.