Case 25-2006 -- A 41-Year-Old Woman with Painful Subcutaneous Nodules

doi:10.1056/NEJMcpc069018

Volume 355:714-722		August 17, 2006		Number 7

Case 25-2006 — A 41-Year-Old Woman with Painful Subcutaneous Nodules

Rebecca B. Campen, M.D., J.D., Christine N. Sang, M.D., M.P.H., and Lyn M. Duncan, M.D.

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Presentation of Case

A 41-year-old woman was referred to the dermatology clinic ofthis hospital for evaluation of painful subcutaneous nodules.She had been well until three years earlier, when several painfulnodules developed on her posterior neck and scalp. She saw herphysician, who noted enlarged left retroauricular and posterioroccipital lymph nodes. A biopsy of an occipital lymph node performedat another hospital disclosed reactive lymphoid hyperplasia,and a biopsy of a scalp lesion showed normal fibroadipose tissue.Radiography of the skull and chest and computed tomography (CT)of the chest, abdomen, and pelvis disclosed no abnormalities.

During the next 15 . . . [Full Text of this Article]

Differential Diagnosis

Pathological Discussion

Syndromes Involving Adipose Tissue

Dr. Rebecca B. Campen's Diagnosis

Pathological Discussion

Discussion of Management

Mechanisms of Chronic Pain

Nociceptive Pain

Neuropathic Pain

Selection of Analgesics

Anatomical Diagnosis

Source Information

From the Department of Dermatology (R.B.C.) and the Dermatopathology Unit (L.M.D.), Massachusetts General Hospital; the Departments of Dermatology (R.B.C., C.N.S.) and Pathology (L.M.D.), Harvard Medical School; and Translational Pain Research, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital (C.N.S.) — all in Boston.