Rare Initial Manifestation of Lupus as Lobular Panniculitis of the Breast—A Case Report and Review of the Literature

Abstract

Lupus mastitis is a rare complication of systemic or discoid lupus erythematosus with an uncommon initial presentation when limited to the breast. In this article, we report a 42-year-old woman who presented with constant pain and tenderness in her breasts. Ultrasound imaging of the left breast revealed a 14-mm oval mass, suspicious for malignancy; a needle core biopsy was performed. Sections showed necrosis of the fat lobules with associated mixed nodular lymphoplasmacytic aggregates. Karyorrhectic debris, fibrinoid necrosis of small vessels, and microcalcifications were all present while the background breast parenchyma was unremarkable. The diagnosis of lupus mastitis was rendered. Subsequent serology showed negative dsDNA but positive antinuclear antibodies, C4, and anti -Sjögren';ssyndrome-related antigen A antibodies. Clinical features of active systemic disease were not identified at the patient's follow-up dermatology appointment 1 month after the biopsy, and she elected management for her nodules with steroids. To the best of our knowledge, only 40 other cases of lupus mastitis have been reported in the English literature, of which 25 presented as a mass and only in 6 lupus mastitis of the breast was the initial presentation. In conclusion, we bring much needed awareness to lupus mastitis as the first presentation of disease.

Get It Off Your Chest: A Narrative Review of Breast Ulcers

“…Lupus mastitis is a rare manifestation of lupus panniculitis first described in 1971. It sometimes is the initial presentation of lupus and can be associated with fat necrosis and ulceration 48 . Because it can mimic breast malignancy, this brings a diagnostic dilemma requiring further investigation and histopathology.…”

“…It sometimes is the initial presentation of lupus and can be associated with fat necrosis and ulceration. 48 Because it can mimic breast malignancy, this brings a diagnostic dilemma requiring further investigation and histopathology. Treatment for lupus mastitis includes antimalarial drugs, systemic corticosteroids, and other immunosuppressive medications.…”

Lupus mastitis in men

“…In the literature, there are around 50 published cases of LM, five of which in men (Kinonen et al, 2010;Sharma et al, 2020;Voizad et al, 2017;Warne et al, 2011). Therefore, a 9:1 ratio for women compared to men.…”

High-Frequency Ultrasound to Assess Activity in Connective Tissue Panniculitis

“…Connective tissue panniculitis (CTP) is a rare cutaneous manifestation of connective tissue diseases associated with lupus erythematosus (LE) and dermatomyositis (DM) [ 1 , 2 ]. CTP usually presents as warm, painful erythematous nodules or plaques [ 3 , 4 , 5 ].…”