Pyoderma gangrenosum may affect the breasts following breast surgery. It is important to consider the diagnosis early in order to avoid complications associated with delayed diagnosis or unnecessary surgery.


The patient may have risk factors for pyoderma (inflammatory bowel disease, monoclonal gammopathy, leukemia, myelodysplasia, etc) but some cases appear to be triggered by the surgery.


The patients presents with one or more painful skin ulcers with or without bullae.


Clinical features:

(1) variable fever

(2) ulcers symmetrical in both breasts, sparing nipples

(3) ulcerated skin lesions elsewhere

(4) absence of regional lymphadenopathy

(5) resistance to antibiotic therapy

(6) response to systemic corticosteroid therapy with or without cyclosporine


Laboratory features:

(1) negative cultures

(2) variable leukocytosis


Differential diagnosis:

(1) cellulitis or necrotizing infection

(2) infarction


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