Images in Clinical Rheumatology
Lupus Mastitis
Mastitis lúpica
Rashmi Roongta, Samir Joshi, Arghya Chattopadhyay
, Alakendu Ghosh
Corresponding author
Department of Clinical Immunology and Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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The lacrimal gland, supraclavicular lymph node and liver slides stained with haematoxylin and eosin showed confluent epithelioid granulomas without necrosis (A–C*). Note the strong histiocytic expression of CD68 in (C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Vílchez-Oya, Juan Antonio Meraz-Ostíz, Irene Carrión-Barberà, Mònica Gonzàlez-Farré, Jose Antonio Carrión, Tarek Carlos Salman-Monte" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Vílchez-Oya" ] 1 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Meraz-Ostíz" ] 2 => array:2 [ "nombre" => "Irene" "apellidos" => "Carrión-Barberà" ] 3 => array:2 [ "nombre" => "Mònica" "apellidos" => "Gonzàlez-Farré" ] 4 => array:2 [ "nombre" => "Jose Antonio" "apellidos" => "Carrión" ] 5 => array:2 [ "nombre" => "Tarek Carlos" "apellidos" => "Salman-Monte" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574322000806?idApp=UINPBA00004M" "url" => "/21735743/0000001800000005/v1_202205130850/S2173574322000806/v1_202205130850/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Lupus Mastitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "312" "paginaFinal" => "313" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rashmi Roongta, Samir Joshi, Arghya Chattopadhyay, Alakendu Ghosh" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rashmi" "apellidos" => "Roongta" ] 1 => array:2 [ "nombre" => "Samir" "apellidos" => "Joshi" ] 2 => array:4 [ "nombre" => "Arghya" "apellidos" => "Chattopadhyay" "email" => array:1 [ 0 => "dr.a.chattopadhyay@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:2 [ "nombre" => "Alakendu" "apellidos" => "Ghosh" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Clinical Immunology and Rheumatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mastitis lúpica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 497 "Ancho" => 1674 "Tamanyo" => 110712 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Gross edema and erythematous swelling of right breast with peau d’orange changes and Acute Cutaneous Lupus Erythematous (ACLE) rash over the chest. (B) Complete resolution of the breast edema and healing ACLE rash after four weeks of treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 45-year-old-woman presented with a non-pruritic, maculopapular rash over her face, chest, and back for four months and a gradually progressive, painful swelling of the right breast and right upper limb for the last two months. There was no fever, loss of weight or appetite, or B-symptoms. On examination, an extensive rash was present on the face, chest, and back with discoid lesions over the ears. The right breast and upper limb were erythematous, swollen, indurated, and tender with peau d’orange changes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). There was no axillary or cervical lymphadenopathy. Her hemogram was unremarkable and other investigations revealed positive anti-nuclear antibody (ANA), low complements, and SS-A, Ro-52, and Ribosomal P positivity on ANA blot. Ultrasound revealed diffuse dermal edema, patent axillary and subclavian veins and no masses. Skin biopsy from the rash showed interface dermatitis. Because of a typical rash, positive ANA, and interface dermatitis on biopsy, oral prednisolone, and hydroxychloroquine was started for lupus-related mastitis and acute cutaneous lupus erythematosus rash. There was rapid improvement in the breast and arm swelling over four weeks (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Lupus Mastitis (LM) is lupus panniculitis involving the mammary gland. It is seen at a mean age of 40 years in patients with pre-established lupus and is associated with discoid lupus erythematosus. It is rare with less than 50 documented cases.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It presents as subcutaneous mass (clinically and radiographically) with skin changes and should be differentiated from infection and malignancy, especially inflammatory breast carcinoma. Irregular, asymmetric masses, coarse calcifications (suggesting fat necrosis), and fibrosis are seen on imaging. Hyaline fat necrosis is the typical histological hallmark of LM. Periseptal/lobular panniculitis, lobular lymphocytic infiltrates and microcalcifications are also seen.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Bilateral lesions should prompt a workup for non-Hodgkin's lymphoma.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Breast abscess and diabetic mastopathy should be considered in appropriate clinical situations. Idiopathic Granulomatous Mastitis (IGM) is a close differential diagnosis with a possible autoimmune etiology but it rarely has calcifications on imaging and biopsy reveals non-caseating granulomas.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Other connective tissue diseases causing mastitis are vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, Behcet's disease, polyarteritis nodosa), granulomatous diseases (sarcoidosis, Crohn's disease), IgG4 related disease and Sjogren's syndrome. These can be differentiated by serology and biopsy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> LM responds well to hydroxychloroquine with or without steroids. Surgery may worsen it, hence an accurate diagnosis is essential.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Contributor information</span><p id="par0015" class="elsevierStylePara elsevierViewall">RR & SJ: Identified and managed the case, write the manuscript. AC: Identified and managed the case and reviewed the manuscript. AG: Identified the case and reviewed the manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patient consent</span><p id="par0020" class="elsevierStylePara elsevierViewall">Written consent has been obtained from the patient for this publication.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial disclosures/funding sources</span><p id="par0025" class="elsevierStylePara elsevierViewall">None of the authors have any financial disclosure or funding sources.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None of the authors have any conflicts of interest to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Contributor information" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Financial disclosures/funding sources" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-24" "fechaAceptado" => "2021-05-25" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 497 "Ancho" => 1674 "Tamanyo" => 110712 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Gross edema and erythematous swelling of right breast with peau d’orange changes and Acute Cutaneous Lupus Erythematous (ACLE) rash over the chest. (B) Complete resolution of the breast edema and healing ACLE rash after four weeks of treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus mastitis: an uncommon complication of systemic or discoid lupus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Kinonen" 1 => "P. Gattuso" 2 => "V.B. Reddy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "901" "paginaFinal" => "906" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus mastitis as a first manifestation of systemic disease: about two cases with a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Voizard" 1 => "L. Lalonde" 2 => "L.M. Sanchez" 3 => "J. Richard-Chesnay" 4 => "J. David" 5 => "M. Labelle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2017.04.023" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2017" "volumen" => "92" "paginaInicial" => "124" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28624010" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic granulomatous mastitis: etiology, clinical manifestation diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Yin" 1 => "X. Liu" 2 => "Q. Meng" 3 => "X. Han" 4 => "H. Zhang" 5 => "Y. Lv" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/08941939.2022.2064009" "Revista" => array:5 [ "tituloSerie" => "J Invest Surg" "fecha" => "2021" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35437114" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mastitis in autoimmune diseases: review of the literature diagnostic pathway, and pathophysiological key players" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Goulabchand" 1 => "A. Hafidi" 2 => "P. Van de Perre" 3 => "I. Millet" 4 => "A.T.J. Maria" 5 => "J. Morel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Clin Med" "fecha" => "2020" "volumen" => "9" "paginaInicial" => "958" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus mastitis: a mimicker of breast carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.R. Warne" 1 => "D. Taylor" 2 => "A. Segal" 3 => "A. Irish" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2011" "paginaInicial" => "2011" "itemHostRev" => array:3 [ "pii" => "S0165032718306426" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001800000005/v1_202205130850/S217357432200079X/v1_202205130850/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001800000005/v1_202205130850/S217357432200079X/v1_202205130850/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357432200079X?idApp=UINPBA00004M" ]
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