XXIII Congresso Brasileiro de Mastologia

Dados do Trabalho


Título

Pyoderma gangrenosum after lumpectomy and mammoplasty responds to the use of anti-TNF monoclonal antibody

Título em Inglês

Pyoderma gangrenosum after lumpectomy and mammoplasty responds to the use of anti-TNF monoclonal antibody

Introdução

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of unknown etiology, which can be triggered after a surgical procedure. It can occur at any surgical site, but it is more common after breast surgeries. The trauma of the surgery can increase levels of inflammatory cytokines and result in a dysfunction of the innate immune system leading to a condition with cellulitis and dehiscence in the surgical wound. Despite PG being a rare condition, the differential diagnosis is important, because the debridement can exacerbate the condition and the antibiotics don’t have clinical effects. We present a case report of PG after a breast surgery.

Relato de caso

A 37-year-old Caucasian female presented with a growing breast lump and the desire to reduce the size of her breasts. The woman had no comorbities, especially no history of autoimmune disorders. In 2009, she performed a primary mammoplasty in another service. At that time, she had a wound infection that resulted in an unfavorable aesthetic result. The patient underwent a lumpectomy at the right breast for a benign tumor (fibroadenoma) that was growing. At the same procedure the plastic surgeon performed a second mammoplasty with a smooth prosthesis. Ten days later she presented with bilateral breast hyperemia, wound purulent discharge and dehiscence, without fever. As all breast lesions sparing the nipple-areola complex, we had a strong suspicion for PG. She was treated with glucocorticoid prednisone 40mg once daily, colchicine 0.5mg twice daily and tumor necrosis factor (TNF) blocker 40mg subcutaneous every 2 weeks. After starting immunobiological therapy, she responded quickly with complete wound healing.
Discussion
PG diagnosis was done by clinical characteristics. It is important to be aware that this condition is frequently mistaken for a wound infection, but antibiotics do not alleviate the condition. Misdiagnosis could lead also to surgical management for wound debridement which would probably make lesions worse. Most PG starts after 4 days to 6 weeks post-operatively. In our case it started at 10 days after the surgery. In this case, the PG occurred after a benign breast surgery with mammoplasty but can also occur after breast cancer surgeries and reconstructions. Our patient didn’t have diseases associated with PG, such as inflammatory bowel disease, spondyloarthritis, rheumatoid arthritis or hematologic malignancy. As reported in the literature, the PG was bilateral, but sometimes it can be unilateral. There have never been any reports describing involvement of the nipples and areolas. We presented a rare case of PG in a woman without risk factors that had a successful treatment with glucocorticoids...

Palavras Chave

Área

DETECTION / DIAGNOSIS - Detection / diagnosis – other

Instituições

CLINICA PARENTE - Santa Catarina - Brasil, HOSPITAL REGIONAL SÃO JOSE HOMERO DE MIRANDA GOMES - Santa Catarina - Brasil, HOSPITAL UNIVERSITARIO POLYDORO ERNANI DE SAO THIAFGO - Santa Catarina - Brasil, MATERNIDADE CARMELA DUTRA - Santa Catarina - Brasil, SOCIEDADE CATARINENSE DE MASTOLOGIA - Santa Catarina - Brasil

Autores

REBECA NEVES HEINZEN, LILIANE RAUPP GOMES PIZZATO, EVANDRO LUIZ MITRI PARENTE, IVANIO ALVES PEREIRA, ADRIANA MAGALHÃES DE OLIVEIRA FREITAS