Depression, anxiety and disabling pain leading to the diagnosis of dercum’s disease

      Originally described in 1892, Dercum’s disease is a rare disorder of unknown etiology associated with chronic, often disabling, analgesics-resistant pain. It presents with wide range of clinical manifestations, making the diagnosis difficult. 47 year old female presented with a longstanding history of treatment resistant depression. Over the last few years she developed intolerable generalized body pain which resulted in different diagnoses such as fibromyalgia, chronic pain syndrome and chronic fatigue syndrome. She had several treatments for pain with little or no response. Within this period she had multiple physicians, with whom she frequently became frustrated, resulting in her firing several doctors. In turn she was also fired by several doctors due to their perception that she was demanding. Over the last year she developed multiple painful nodular swellings all over her body, especially concentrated around her abdomen and joints. She had a biopsy of one of the nodules and histology showed adipose tissue. A diagnosis of adiposis dolorosa (Dercum’s disease) was made. Up until the time of the present admission, she responded poorly to all treatments for pain. Dercum’s disease is a rare condition characterized by multiple, painful subcutaneous lipomas. Diagnosis is frequently missed due to its myriad manifestations including significant neuropsychiatric symptoms. Dercum’s disease is difficult to treat. Multiple pain control trials have not been promising for long term pain control. Multidisciplinary approach including pain consultants is required to effectively manage these patients. This case highlights the difficulties in diagnosis and treatment of Dercum’s disease.