Background Breast Vasculitis is rare and may occur in isolation or as part of systemic vasulitis. We present a case of isolated breast vasculitis in a 21 year old female. The breast mass was extensive and surgical treatment would have resulted in disfiguring surgery with reconstruction.Medical treatment of IVB has been sparsely reported in the medical literature. Most case reports demonstrate surgical treatment. Our case was treated successfully with prednisolone.
Objectives Our aim is to highlight the therapeutic benefit of steroids as an alternative to surgery in breast vasculitis.
Methods A 21 year old college student was initially seen by a breast surgeon with a 2 month history of a breast lump. A subsequent biopsy revealed evidence of vasculitis (see below) and she was referred to the rheumatology clinic. She denied any symptoms suggestive of systemic vasculitis.
Examination revealed a diffuse firm mass in the upper outer quadrant of the right breast, measuring approximately 15 cm in width. There were no signs of systemic vasculitis on examination.
Results ESR 2 mm/hr, CRP 5mg/l, ANCA negative. FBC, U&E, LFT, CK, TFT and bone profile all normal.Urinalysis negative for blood and protein. ANA, RA, anticardiolipin, thrombophilia screening, hepatitis serology were all negative. Immunoglobulin, complement and serum protein electrophoresis were normal. A CXR was normal.
Ultrasound of the right breast showed an extensive, ill defined, area of increased echo texture involving skin, subcutaneous fat and breast tissue. The overlying skin was thickened. The mass width was approximately 15cm.
Two sets of core biopsy were done. The biopsy from the upper outer quadrant showed inflammatory changes only. Biopsy from the centre of the lesion revealed evidence of vasculitis(necrotic debris within the wall of a medium sized artery and proliferation of intima). There was no evidence of malignancy. The differential diagnosis included polyarteritis nodosa, microscopic polyangiitis and granulomatosis with polyangiitis (Wegener’s). On the basis of the biopsy, she was referred to rheumatology for consideration of immunosuppressive therapy.
She was started on prednisolone 60 mg per day. She had serial ultrasound examinations at 2 and 4 weeks after treatment initiation. This showed on going reduction in size of the breast lump which continued. After 3 months of treatment the breast lump resolved.
Conclusions The mainstay of treatment of IVB in the literature has been surgical. Corticosteroid therapy has only been considered for those with systemic manifestations. The previously reported cases of IVB were older women; however, our patient was only 21. She was treated with systemic steroid in order to avoid mastectomy. The outcome was resolution of the mass and a happy patient.
Trueb R.M et al.(1997) Br J of Dermatol. 137, 799-803.
Trueb et al.(1999). Br J Dermatol. 141(6):1117-21.
Hernadez-Rodriguez J et al. (2008) Medicine (Baltimore).87(2):61-9.
Disclosure of Interest None Declared