An unusual presentation of Dercum’s disease to the emergency department

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Abstract
A 54-years-old-obese female (Body mass index 32) presented to the emergency department with multiple painful nodules on her abdomen and back for the past 2 years. Later, patient reported developing similar nodules on her scalp ( Fig. 1A) and on the tip of the left fifth digit ( Fig. 1B and C) in the past 6 months. There were no associated systemic signs or symptoms. Her prior medical, family and medication history were unremarkable. On local examination, the lesions were of different sizes, nodular and painful to touch. Rest of her systemic examination was normal. She was successfully managed with analgesia and was referred to general surgery clinic where an excisional biopsy of her scalp lesion was performed. The biopsy was reported to show a lipoma with inflammation ( Fig. 2). The patient has yet to revisit for follow-up.