[Fasciitis-like primary breast pyoderma gangrenosum: A rare case report]

Area of Science:

• Dermatology
• Immunology

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis.
• Breast involvement is uncommon, often associated with prior surgery.
• Diagnosis is challenging due to its exclusion nature and mimicry of other conditions.

Purpose of the Study:

• To report a rare case of spontaneous pyoderma gangrenosum on the breast.
• To highlight diagnostic challenges and emphasize PG as a differential diagnosis for non-healing breast lesions.

Main Methods:

• Case report of a 41-year-old woman with common variable immunodeficiency and autoimmune thrombocytopenia.
• Initial misdiagnosis as necrotizing soft tissue infection (NSTI) leading to debridements and antibiotics.
• Histopathological examination and subsequent clinical evolution leading to PG diagnosis.

Main Results:

• The patient presented with a spontaneous inflammatory breast ulcer that rapidly progressed.
• Despite initial treatment for suspected NSTI, the condition showed slow improvement.
• Recurrent lesions appeared on the contralateral breast and donor site, supporting the PG diagnosis.

Conclusions:

• Spontaneous pyoderma gangrenosum of the breast is exceptionally rare.
• PG should be considered in refractory breast dermo-hypodermitis, especially in patients with underlying systemic conditions.
• Early consideration of PG can prevent delayed diagnosis and inappropriate treatments.