Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor - Case Letter
2016:82:2;202-204
doi: 10.4103/0378-6323.164219
PMID: 26345654

Plantar erythema nodosum associated with granulomatous mastitis

Mualla Polat, Hatice Kaya
 Department of Dermatology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey

Correspondence Address:
Mualla Polat
Department of Dermatology, Faculty of Medicine, Abant Izzet Baysal University, 14280 Golkoy-Bolu
Turkey
How to cite this article:
Polat M, Kaya H. Plantar erythema nodosum associated with granulomatous mastitis. Indian J Dermatol Venereol Leprol 2016;82:202-204
Copyright: (C)2016 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Granulomatous mastitis is a rare benign breast disease that has clinical and radiological findings similar to those of breast cancer. Although its etiology is unclear, it commonly coexists with Wegener′s granulomatosis, sarcoidosis, diabetes mellitus, leprosy, and connective tissue disorders. It is rarely reported in association with erythema nodosum. [1],[2],[3]

Erythema nodosum is a reactive dermatosis with inflammation of the subcutaneous fat. It typically presents as an acute eruption of erythematous, tender subcutaneous nodules over the pretibial areas. Plantar erythema nodosum is rare and is usually seen in children or people with systemic diseases such as Crohn′s disease, Takayasu′s arteritis and after treatment with infliximab. [4],[5] We were unable to find any previous reports of plantar erythema nodosum associated with granulomatous mastitis.

A 30-year-old female presented to the dermatology outpatient clinic of Abant Izzet Baysal University Hospital in Turkey with a firm, painful lump in her left breast for 4 weeks. She had also been complaining of swelling of the soles of her feet for 2 weeks. She was a non-smoker and had no history of fever, night sweats, weight loss or hemoptysis. Examination revealed red, tender subcutaneous nodules on the soles of her feet [Figure - 1]a and a firm, tender, 5 × 2 cm indurated lump in the left breast. There was no lymphadenopathy and abdominal ultrasonography was normal. Test results revealed an erythrocyte sedimentation rate of 59 mm/h and C-reactive protein of 66.2 mg/L. Serum immunoglobulins and complement were normal and autoantibodies were negative. A biopsy specimen from her foot revealed mononuclear cell infiltration comprising of histiocytes, lymphocytes, rare eosinophils and slightly increased fibrous tissue within the septae of the subcutaneous fat [Figure - 1]b. Fine-needle aspiration biopsy of the breast mass revealed a granuloma with multinucleated Langerhans giant cells, neutrophils, small lymphocytes and epithelioid cells predominantly associated with the breast lobules [Figure - 2]. Bacterial, fungal and mycobacterial cultures of the aspirated specimen were negative. Chest X-ray was normal and a Mantoux test was negative. A diagnosis of erythema nodosum and granulomatous mastitis was made. Total excision of the breast lump was performed. The patient did not receive any antibiotics or antitubercular treatment prior to surgery. The erythema nodosum disappeared within 1 week after surgery without treatment. No recurrence has been noted after 10 months.

Figure 1: (a) Multiple erythematous nodules on the plantar aspect of the foot. (b) Mononuclear cell infiltration within the septa of subcutaneous fat tissue (H and E, ×20)
Figure 2: Granulomatous microabscesses in the lumen of the breast ducts and periductal region consisting of neutrophils and epithelioid histiocytes with partial giant cell formation (H and E, ×20)

Our patient displayed the typical clinical profile of idiopathic granulomatous mastitis as described by Kessler and Wolloch, namely the development of a very hard, painful breast lump. [1] The histological features of lymphocytes and epithelioid cells predominantly associated with the breast lobules were also typical. [1],[6]

Plantar nodular erythema is rare. Some authors have interpreted plantar nodular erythema as erythema nodosum, others as plantar eccrine hidradenitis based on histological grounds and some as unconfirmed trauma-induced change (dancing or pressure urticaria). [4],[5]

Hern and Schwayder reported the first case of erythema nodosum localized to the plantar surfaces, [4] followed by other reports. Histological confirmation was reported in only some of the cases. Conditions associated with plantar nodular erythema included increased antistreptolysin O titers, positive IgM for rubella and Mycoplasma, and ongoing infections with group A Streptococcus, Yersinia enterocolitica, and Mycobacterium tuberculosis. [5]

Granulomatous mastitis with erythema nodosum has rarely been reported in the English-language medical literature. [3],[5] This association was first reported by Adams in 1987. [3] It was associated with postpartum altered immune status; other granulomatous diseases including tuberculosis and sarcoidosis were excluded.

References
1.
Kessler E, Wolloch Y. Granulomatous mastitis: A lesion clinically simulating carcinoma. Am J ClinPathol 1972;58:642-6.
[Google Scholar]
2.
Pandhi D, Verma P, Sharma S, Dhawan AK. Borderline -lepromatous leprosy manifesting as granulomatous mastitis. Lepr Rev 2012;83:202-4.
[Google Scholar]
3.
Adams DH, Hubscher SG, Scot DG. Granulomatous mastitis−A rare cause of erythema nodosum. Postgrad Med J 1987;63:581-2.
[Google Scholar]
4.
Hern AE, Shwayder TA. Unilateral plantar erythema nodosum. J Am Acad Dermatol 1992;26:259-60.
[Google Scholar]
5.
Sanchez-Viera M, Lecona M, Soto-Melo J. Plantar erythema nodosum of childhood. J Am Acad Dermatol 1993;29:284.
[Google Scholar]
6.
Al-Khaffaf BH, Shanks JH, Bundred N. Erythema nodosum- An extramammary manifestation of granulomatous mastitis. Breast J 2006;12:569-70.
[Google Scholar]

Fulltext Views
69

PDF downloads
46
Show Sections