A Case of Erythema Nodosum with Granulomatous Mastitis in a Pregnant Woman

KUROKI  Rie, HIGUCHI Mutsumi, YAMAGUCHI  Mina, KAWAMOTO Shunji, IMAFUKU Shinichi

doi:10.2336/nishinihonhifu.76.540

A 39-year-old pregnant woman at 31 weeks gestation was admitted to our hospital because of painful red nodules on both her legs. She was diagnosed as erythema nodosum associated with pregnancy and medicated with prednisolone (20 mg/day). After 6 days of corticosteroid therapy, the nodular induration and tenderness had decreased. She had also noted a lump in her left breast since 27 weeks gestation. On breast ultrasound examination, a nodule of 5 × 3 cm in diameter was detected in her left breast. A fine-needle biopsy suggested breast carcinoma based on histological appearance. At 34 weeks gestation, a Caesarean section was performed after completion of corticosteroid therapy. During the post-partum period, the condition of the left breast lesion worsened with fever and arthralgia. Because the painful red nodules on both legs were not diminished,we performed skin biopsy of a nodule in the left leg and identified erythema nodosum by histological examination. We now doubted the former histopathological diagnosis of the left breast and considered an alternative diagnosis of granulomatous mastitis accompanied by erythema nodosum. A fine-needle biopsy of the left breast was performed again, and a histological examination finally revealed granulomatous mastitis. Administration of prednisolone at 30 mg/day resulted in disappearance of nodules on both legs and a gradual regression of the mass lesion in the left breast.

A Case of Erythema Nodosum with Granulomatous Mastitis in a Pregnant Woman

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