Pyoderma gangrenosum: Report of a case involving the breast.

Authors: Andressa G. Amorim, Marcellus N. M. Ramos, Felipe A. Cavagna, Maria I. B. A. C. Sawada,

Alexandre S. Melitto, André Mattar, Jorge Y. Shida, Luiz H. Gebrim.

Institution:

Women’s Reference Center

Perola Byington Hospital

São Paulo – Brazil

Background: Pyoderma gangrenosum (PG) is an inflammatory, ulcerative skin disorder characterized at

histopathology by the presence of neutrophils in the skin. The disease is a rare but serious ulcerating skin

disease, the treatment of which is mostly empirical. The condition may either develop spontaneously or in

association with surgical trauma or systemic or neoplastic diseases. Pyoderma can present to a variety of

health professionals and several variants exist that may not be recognized immediately. This can delay the

diagnosis and have serious clinical consequences. Clinical presentation varies, but is basically characterized

by ulcerated, painful, dark red or purple skin lesions with irregular, inflamed and raised borders and a

necrotic base, with single or multiple small abscesses. The mainstay of treatment is long term

immunosuppression, often with high doses of corticosteroids or low doses of ciclosporin. Recently, good

outcomes have been reported for treatments based on anti-tumour necrosis factor α, and infliximab proved

effective in a randomized controlled trial.

Case Report: This report refers to a female patient who was 54 years old and that was seen in Perola

Byington Hospital. She presented with spontaneous pyoderma gangrenosum and the lesions were seen on

her right breast, left axilla, left eyelid and chin. She was submitted to a skin biopsy in 07/06/2017: chronic

non-specific inflammatory disease. After the clinical and pathologic result, the hypothesis of PG was made,

and she received systemic corticosteroids with prednisone 60mg once a day orally for 30 days and after that

more 90 days with prednisone 40mg. She had responded very well, and the lesions disappeared after 4

months.

Discussion: The clinical course of pyoderma gangrenosum can be unpredictable and highly variable from

onset and throughout progression of the condition; hence diagnosis of this pathology may constitute a

challenge. Many patients develop painful lesions that grow progressively, accompanied by fever. In others,

lesions are chronic, with ulcerations that progress slowly. Pathogenesis remains to be fully clarified. Since

diagnosis is reached exclusively on the basis of clinical characteristics, it is very important to take this

disease into consideration when evaluating differential diagnoses.

Keywords: breast; pyoderma gangrenosum; neutrophilic infiltrate; ulcer