Presenter: Rachel Cetta DO, Sonam Rama DO
Dermatology Program: SCS/MSUCOM/Beaumont Hospital-Trenton
Program Director: Steven Grekin DO
Submitted on: May 5, 2017
CHIEF COMPLAINT: Painful nodules located on her back and arms
CLINICAL HISTORY: A 55-year-old female with bipolar disorder, osteoarthritis, pulmonary embolism, deep vein thrombosis, breast cancer, and depression was referred to our office complaining of painful nodules located on her back and arms. The patient reported the lesions on her upper extremities and trunk had been present for forty plus years and had endured twenty-four excisions to remove these nodules. Patient stated the nodules were tender to palpation and would get severe sharp shooting pain in these lesions. Patient had tried gabapentin but it caused her to have dizziness, and patient was currently being treated with pregabalin (50 mg BID) for alleviation of pain. This did control the pain at times, but did not take it away completely.
Medications: Lithium, valproic acid, quetiapine, lorazepam, pregabalin, baclofen and oxycodone with acetaminophen (as needed)
PHYSICAL EXAM:
On physical exam, multiple squishy subcutaneous nodules on bilateral arms with scars were noted as well as multiple subcutaneous nodules on the back with scars.
LABORATORY TESTS: N/A
DERMATOHISTOPATHOLOGY: N/A
DIFFERENTIAL DIAGNOSIS:
1. Adiposis Dolorosa (Decrum’s Disease)
2. Familial multiple lipomatosis
3. Madelung’s disease
4. Proteus Syndrome
5. Gardner Syndrome
