Abstract:

A 29-year-old Latina female presented to the dermatology clinic with a three-month history of nodules on the legs. The lesions started as a few nodules on her right foot, then, in a few hours, spread to both of her legs and extended upwards to the mid-thigh. Lesions were warm, tender, and pruritic, but symptoms resolved prior to presentation. Associated symptoms included joint pain in her wrists, knees, and ankles; and morning stiffness of her fingers that started around the same time as her mastitis. Three weeks prior to her leg eruption, she presented to breast surgical clinic with swelling and tenderness of the right lateral breast with clear discharge from the nipple. The breast lesion was initially a small painless lump that developed a few months prior to presentation and progressed. Ultrasound of the breast showed a 6.5cm confluent hypoechoic area consistent with idiopathic granulomatous mastitis which was confirmed on biopsy. Aerobic culture of the breast discharge grew Corynebacterium Kroppenstedtii and was subsequently treated with one week of antibiotics. One week later, she presented to the emergency department with tender erythematous nodules on her legs along with worsening of swelling and erythema of her right breast. Erythema nodosum was the suspected diagnosis and she was started on a 3-week prednisone taper and referred to Dermatology. At time of dermatology visit, the nodules on her legs were no longer tender and her granulomatous mastitis was slowly improving post-prednisone treatment. At that time, prior work-up included chest x-ray, which was unremarkable and T spot and ANA, both which were negative. A clinical diagnosis of erythema nodosum in association with granulomatous mastitis was made; and given the resolution of her EN, no further work-up or management was initiated. She continues to follow-up with the surgical breast clinic for longitudinal management of her slowly improving granulomatous mastitis.

Financial Disclosure:
No current or relevant financial relationships exist.

Menu

Duaa AbdelHameid, MD