Can Lupus Mastitis be Treated Surgically?

Abstract

Lupus mastitis is a rare chronic inflammatory reaction of the sub-cutaneous fatty tissue of the breast and may appear in 2-3% of patients with systemic lupus erythematosis. Surgical intervention is not needed for the treatment of lupus mastitis, and if necessary the least invasive procedure should be chosen. In this case, despite the use of hydroxychloroquine and oral steroids, patient with malignancy risk and ongoing complaints went to excision. Surgery appears to be effective in patients with ongoing complaints despite the adequate medical treatment.

Lupus mastitis: Suspicious breast lesion as a rare presentation of lupus

“…Even though previous core biopsies didn't show cellular atypia, the patient had skin alterations such as erythema and edema, and in some inflammatory breast cancers atypia is not found on core biopsies. In the light of the actual knowledge on this rare disease, surgical procedures are not yet consensual for lupus mastitis, so, we must emphasize that our patient had no previous lupus diagnosis, which made the breast disease even more difficult to diagnose [3,13]. Despite this, the short number of reported cases where patients with lupus mastitis have been submitted to surgical procedures is not enough to draw conclusions on this matter.…”

Lupus Mastitis in a Young Female Mimicking a Breast Carcinoma; a Rare Entity Through a Case Report and Review of the Literature

“…Antimalarial drugs are the primary medical treatment option for LM, corticosteroids may also be used in combination or alone. Surgery should only be considered in patients with ongoing complaints despite appropriate medical treatment, because of the possibility of triggering the risk of additional exacerbations (3,12). In summary, we reported an unusual case of LM in a female with a known case of SLE.…”

“…The laboratory analysis yielded hemoglobin (Hb): 10.9 g/dl (12)(13)(14)(15)(16), white blood cells: 2690 /mm3 (4500-11000) with neutrophils 53.5 %, Urea: 17 mg/dl, creatinine: 0.58 mg/dl, fasting blood glucose: 91 mg/dl, Hba1c:5.6%, platelets: 127000/mm3, and 24 hrs urine protein 1.36 gr/day. The anti-ribosamal antibody and anti-nucleosomes were positive other lupus antibodies were negative.…”

Lupus mastitis in men

“…After the diagnosis, the initial treatment should be clinical. The use of hydroxychloroquine, an antimalarial, is considered the first therapeutic option (Cerveira et al, 2006;Dandinoglu et al, 2013;Voizad et al, 2017). The recommended dose for LM treatment is 200mg/day (Summers et al, 2009).…”

“…Surgical treatment through mastectomy should be avoided since surgical trauma can favor the progression and the disease worsening. Surgical procedures are reserved only for cases clinically refractory to drug therapies and in situations where there is a high suspicion of malignancy (Bayar et al, 2007;Castro et al, 2004;Cerveira et al, 2006;Dandinoglu et al, 2013;Summers et al, 2009). The follow-up of the patient is necessary to monitor the evolution of the condition and possible recurrences.…”