Interchanging autoimmunity - lupus mastitis coexisting with systemic polyarteritis nodosa

Abstract

Lupus mastitis is an uncommon presentation of lupus erythematosus profundus (LE profundus), characterized by inflammation of the subcutaneous fat. LE profundus occurring as initial manifestation of LE is rare. We report a case where the patient presented with lupus mastitis and years later, she developed disseminated discoid LE (DLE) and polyarteritis nodosa (PAN). PAN and DLE are connective tissue diseases with different etiologies, clinical, immunological, and histopathological features. One connective tissue disease evolving into another is rare, and the reasons remain unexplained. This woman had histopathologically proven DLE and lupus mastitis with a negative antinuclear antibody profile. She satisfied the American College of Rheumatology criteria for PAN.

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

“…It is advisable to avoid biopsy if the diagnosis can be established with the clinical and radiological features (especially the unusual mammographic calcification) because it may worsen the condition. However, FNA will be helpful if there is a doubt about the diagnosis or when the swelling is localized (1,5,8). Accurate patient history and knowledge of the typical imaging appearance of LM may help prevent or minimize biopsy and surgical intervention, which carries the potential for the disease exacerbation (8,9).…”

“…However, FNA will be helpful if there is a doubt about the diagnosis or when the swelling is localized (1,5,8). Accurate patient history and knowledge of the typical imaging appearance of LM may help prevent or minimize biopsy and surgical intervention, which carries the potential for the disease exacerbation (8,9). Histologically, most LM cases show lymphocyte-predominant inflammation involving breast ducts, lobules, vessels, and adipose tissue, with hyaline fat necrosis being the most characteristic finding (10).…”

Lupus mastitis in men

“…Approximately 50% of patients with panniculitis have mild types of systemic lupus (Summers et al, 2009). In the literature, although rare, there are reports of association of LM with other autoimmune diseases, such as polyarteritis nodosa (Vineetha et al, 2016). In men, mastitis was associated with the antiphospholipid antibody syndrome (Martella et al, 2008).…”