Pyoderma gangrenosum localized on the breast

Year 2015, Volume: 32 Issue: 1, 47 - 49, 28.04.2015

Talat Ayyıldız , Çınar Yıldırım Işıl Tilki Günay Şaduman Balaban Adım Enver Dolar

Abstract

Breast ulceration is usually associated with breast cancer. However, it is important to know other factors that may be involved in its etiology. In this case report, we presented a very rare cause of pyoderma gangrenosum (PG) in the breast of a female patient without any prior history of breast tissue trauma or surgical intervention. More than one-half of PG cases develop in association with an underlying systemic condition including inflammatory bowel disease (IBD), hematologic disorder and arthritis. In contrast to other extraintestinal manifestations, cutaneous and ocular disorders occur at equal frequency in both Crohn’s disease and ulcerative colitis. PG has been detected in 0.75% of IBD patients. It usually is related to the activity of colitis. The classic lesion begins as erythematous pustules or nodules. The patients with ulcerative PG have had an associated disease such as IBD, arthritis, monoclonal gamapathy, and internal malignancy. Lesions may be single or multiple. It can be resolved by treatment of the underlying colitis. For mild localized cases, topical corticosteroid or topical tacrolimus should be considered as the first choice. Severe cases can require systemic glucocorticoids, immunosuppressants or anti-TNF therapy. This case differs from others reported in the literature because in addition to breast, hand and foot lesions consistent with pyoderma gangrenosum were also present in this patient.

Keywords

Breast, Inflammatory bowel disease, Pyoderma gangrenosum, Ulcer

References

• Ahronowitz, I., Harp, J., Shinkai, K., 2012. Etiology and management of pyoderma gangrenosum: A comprehensive review. Am. J. Clin. Dermatol. 13, 191-211. doi: 10.2165/11595240-000000000-00000.
• Bennett, M.L., Jackson, J.M., Jorizzo, J.L., Fleischer, A.B. Jr., White, W.L., Callen, J.P., 2000. Pyoderma gangrenosum. A comparison of typical and atypical forms with an emphasis on time to remission. Case review of 86 patients from 2 institutions. Medicine (Baltimore). 79, 37-46.
• Binus, A.M., Qureshi, A.A., Li, V.W., 2011. Winterfi eld, L.S. Pyoderma gangrenosum: A retrospective review of patient characteristics, comorbidities and therapy in 103 patients. Br. J. Dermatol. 165, 1244-1250. doi: 10.1111/j.1365-2133.2011.10565.x.
• Brooklyn, T.N., Dunnill, M.G., Shetty, A., Bowden, J.J., Williams, J.D., Griffi ths, C.E., Forbes, A., Greenwood, R., Probert, C.S., 2006. Infl iximab for the treatment of pyoderma gangrenosum: A randomised, double blind, placebo controlled trial. Gut. 55, 505-509. doi: 10.1136/gut.2005.074815.
• Callen, J.P., 1998. Pyoderma gangrenosum. Lancet. 351, 581-585.
• Duke, G., Al Samaraee, A., Husain, A., Meggitt, S., Fasih, T., 2012. Pyoderma gangrenosum: A rare cause of breast ulceration. Ochsner J. 12, 155-158.
• Farhi, D., Cosnes, J., Zizi, N., Chosidow, O., Seksik, P., Beaugerie, L., Aractingi, S., Khosrotehrani, K., 2008. Signifi cance of erythema nodosum and pyoderma gangrenosum in infl ammatory bowel diseases: A cohort study of 2402 patients. Medicine (Baltimore). 87, 281-293. doi: 10.1097/MD.0b013e318187cc9c.
• Ruocco, E., Sangiuliano, S., Gravina, A.G., Miranda, A., Nicoletti, G., 2009. Pyoderma gangrenosum: an updated review. J. Eur. Acad. Dermatol. Venereol. 23, 1008-1017. doi: 10.1111/j.1468-3083.2009.03199.x.
• Tromm, A., May, D., Almus, E., Voigt, E., Greving, I., Schwegler, U.,Griga, T., 2001. Cutaneous manifestations in infl ammatory bowel disease. Z. Gastroenterol. 39, 137-144.
• Fig. Posttreatment healing of the left ankle with cicatrice.