Angiolipomatous Atypical Presentation of Dercum's Disease

We describe the case of a 35-year-old man presenting with multiple painful soft tissue masses in bilateral upper extremities, the trunk, and groin. The patient had a prior history of painful lipomatosis in the left upper extremity with multiple masses removed without intraoperative or postoperative complications. Physical examination revealed multiple right upper extremity nodules that triggered reproducible pain upon palpation. Magnetic resonance imaging (MRI) confirmed the presence of multiple subcutaneous lipomatous masses with variable nonlipomatous internal signal in some of the masses. He was managed surgically, and 36 distinct subcutaneous soft tissue masses were resected across three operations. Histopathology following these resections revealed 13 angiolipomas, a rare finding for Dercum's disease, and 23 lipomas. This is the first reported case of Dercum's disease presenting with multiple angiolipomas in the absence of prior trauma to the affected region, distributed across multiple body regions rather than localized to one specific extremity.