• Dercum's disease can be easily mistaken for a multitude of other diseases, especially in the elderly population, so a high index of suspicion is needed for early diagnosis and correct treatment of this disease entity.
• Dercum's disease most present as a multilesional disorder but can also present as a unilesional disorder as in our patient.
• As genetic factors are involved in the pathogenesis of Dercum's disease, relatives should be instructed and educated about this disease and their enhanced risk of developing similar symptoms.
• The use of intralesional lidocaine injection need to be considered as an alternative effective therapy in patients with Dercum's disease, avoiding systemic side effects, cost, and frequent cardiac monitoring of patients receiving intravenous lidocaine infusion (Table 4).
• Further research is needed to define the genetic basis of this condition, hoping that a subsequent curative treatment will be available.