Pyoderma gangrenosum mimicking inflammatory breast cancer

Pyoderma gangrenosum (PG) is a rare inflammatory dermatosis characterised by painful ulcerations. The onset of the condition may be sudden and its course rapid. Moreover, early diagnosis and application of appropriate treatment are important as the disease can lead to numerous complications. We present a case of a female patient with diagnosed PG mimicking inflammatory breast cancer.
A 61-year-old patient was admitted to the Department of Dermatology to diagnose and treat skin lesions manifesting as ulceration of the left breast and erythema localised on the trunk with concomitant extensive sclerosis of the subcutaneous tissue (Figure 1 A). The patient suffered from internal disorders, including type 2 diabetes, arterial hypertension, hypothyroidism and obesity. Before admission to the Department of Dermatology the patient was hospitalised in the Internal Ward due to fever and persisting weakness. During the hospitalization, large, flaccid bullae with accompanying erythema occurred on the skin of the left breast, followed by corresponding skin lesions on the trunk. Wound swabs were collected and three types of bacteria were cultured (Staphylococcus spp., coagulase neg., Corynebacterium sp., Acinetobacter baumannii). The patient was isolated and targeted intravenous antibiotic therapy was initiated. The intensive treatment did not lead to clinical improvement, the ulceration within the left breast occurred and the patient was referred to the Department of Dermatology. During the hospitalization we observed increased blood inflammatory markers (C-reactive protein 58.80 mg/dl, erythrocyte sedimentation rate after 1 h 85 mm, total protein value 7.7 g/dl). Serum protein electrophoresis demonstrated increased levels of globulins,  globulins and hypoalbuminemia. Blood cell count demonstrated a slightly increased platelets level, up to 386 × 103/µl, monocytosis and eosinopaenia. Moreover, antistreptolysin was 200 IU/ml, anti-nuclear antibodies (ANA) were positive at a titre of 1 : 320 with a cytoplasmic type of luminescence, rheumatoid factor was 8 IU/ml. Gram-negative bacilli were cultured from the swab of the left breast ulceration and assessed as a contamination. Ultrasound examination of the left breast revealed an apnoeic area with hyperechogenic streaks in the inferior internal quadrant suggesting an organising liquid area. Inflammatory breast cancer could not be excluded in the radiologist’s opinion (Breast Imaging-Reporting and Data System USG...


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