Sona Trika, BA
Fourth Year Medical Student
Western University of Health Sciences College of Osteopathic Medicine of the Pacific
San Diego, California, United States
Amer Aldaas, BS
Medical Student
A.T. Still University School of Osteopathic Medicine in Arizona
San Diego, California, United States
Roger Kasendorf, DO
Physician/adjunct associate professor
Roger Kasendorf, DO PC/Western Osteopathic Medical School, Midwestern Osteopathic Medical School
La Jolla, California, United States
Dercum’s disease
Case Description: This case describes a 57-year-old female with Hashimoto’s disease and rheumatoid arthritis presenting with Dercum’s disease after an extensive workup and misdiagnosis of fibromyalgia. Her lipomas are widespread, especially in areas of physical injury. After a fall in March 2023, she had a right elbow laceration and stitches. Once healed, she complained of painful “bumps” at the site. She also experienced right thigh numbness and tingling, later becoming a severe burning sensation. A lumbar MRI revealed spinal enthesopathy and epidural lipomatosis from L5-S1, effacing the spinal canal below S1-S2. She continued developing new, tender subcutaneous lipomas.
Discussions:
Dercum’s disease, also known as Adiposis Dolorosa, is a rare and painful disorder characterized by the growth and presence of multiple subcutaneous lipomas. These lipomas most commonly present in a symmetrical pattern on the trunk, upper extremities, and lower extremities. The etiology and prevalence of this condition is largely unknown, and there is scarce evidence to show how Dercum’s affects life expectancy. The lack of standardized treatment guidelines leads to frequent misdiagnosis due to the resemblance of its lipomas to benign masses. Management necessitates a multifaceted approach involving pain management, physical therapy, surgical interventions, and psychological support. Despite a century-long presence in medical literature, advancements in alleviating patient suffering remain minimal.
Conclusions: Dercum's disease presents a unique diagnostic and therapeutic challenge due to its rarity, poorly understood etiology, and symptomatic overlap with other conditions such as fibromyalgia. The case presented illustrates the complexities in recognizing and managing this disorder, particularly when initial diagnoses may obscure the underlying pathology. Our patient’s experience with post-injury lipoma development and associated neurological symptoms highlights the need for heightened clinical awareness and a tailored, interdisciplinary approach to treatment. Further research is crucial to improve diagnostic accuracy and develop standardized treatment protocols, ultimately enhancing patient outcomes.
