Experience of Two-Year Observation of а Patient with Dercum Disease During Methotrexate Therapy

Dercum disease, also known as painful lipomatosis, neurolipomatosis, Ander’s syndrome, is a rare illness. The main clinical manifestation of this disease is the presence of painful formations of subcutaneous tissue, localized in various parts of the body: on the limbs, trunk, buttocks. Possible etiological factors include genetic mutations, the presence of abnormal cellular proteins, endocrine disorders, changes in the nervous system. This disease is more common among women over 35 years old. Cases of Dercum disease in children and adolescents are rare. Patients with this disease are often overweight. There are 4 types of Dercum disease: generalized diffuse, generalized nodular, localized nodular, juxta-articular forms. In some cases, acute inflammatory markers increase: the erythrocyte sedimentation rate, C-reactive protein. A high level of tumor necrosis factor-α with a decrease over time was also noted in the presented clinical case, it requires further study of the prognostic capabilities as a marker of disease activity. Histological examination of subcutaneous elements did not reveal specific changes (the morphological picture corresponds to lipoma). Various methods of therapy are discussed in the literature, including liposuction, massage. Non-steroidal anti-inflammatory drugs, glucocorticoids, methotrexate also may be used. The clinical case presents a 42-year-old female patient with complaints of the presence of painful local nodular skin lesions of various sizes on the upper and lower extremities. We describe the early diagnosis of Dercum disease with differential diagnosis with panniculitis of other etiologies and the achievement of stable remission against the background of methotrexate therapy.

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