Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman
Mendrika Fifaliana Rakotoarisaona,1 Tsiory Irintsoa Razafimaharo,1 Naina Harinjara Razanakoto,1 Fandresena Arilala Sendrasoa,1 Anne Ducournau,2 Christine Devalland,3 Anne-Sophie Dupond,2 Irina Mamisoa Ranaivo,4 Lala Soavina Ramarozatovo,1 Fahafahantsoa Rapelanoro Rabenja1 1Department of Dermatology,...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-03-01
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| Series: | International Medical Case Reports Journal |
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| Online Access: | https://www.dovepress.com/idiopathic-granulomatous-mastitis-as-an-unusual-cause-of-erythema-nodo-peer-reviewed-fulltext-article-IMCRJ |
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| author | Rakotoarisaona MF Razafimaharo TI Razanakoto NH Sendrasoa FA Ducournau A Devalland C Dupond AS Ranaivo IM Ramarozatovo LS Rapelanoro Rabenja F |
| author_facet | Rakotoarisaona MF Razafimaharo TI Razanakoto NH Sendrasoa FA Ducournau A Devalland C Dupond AS Ranaivo IM Ramarozatovo LS Rapelanoro Rabenja F |
| author_sort | Rakotoarisaona MF |
| collection | DOAJ |
| description | Mendrika Fifaliana Rakotoarisaona,1 Tsiory Irintsoa Razafimaharo,1 Naina Harinjara Razanakoto,1 Fandresena Arilala Sendrasoa,1 Anne Ducournau,2 Christine Devalland,3 Anne-Sophie Dupond,2 Irina Mamisoa Ranaivo,4 Lala Soavina Ramarozatovo,1 Fahafahantsoa Rapelanoro Rabenja1 1Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar; 2Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France; 3Department of Pathology, Nord Franche-Comté Hospital, Trevenans, France; 4Department of Dermatology, University Hospital Morafeno, Toamasina, MadagascarCorrespondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Rue Dr Davioud Jacques, Antananarivo, 101, Madagascar, Tel/Fax +261 34 61947 34, Email lulubslj@gmail.comIntroduction: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Neoplastic and infectious etiologies must be ruled out. IGM is a diagnostic challenge for countries with high tuberculosis endemicity like Madagascar since it may clinically and radiologically mimic breast tuberculosis. We report a case of IGM associated with erythema nodosum in a Malagasy.Case Report: A 29-year-old primiparous woman came to a dermatological consultation for typical erythema nodosum lesions that appeared one month after a breast swelling. She had no particular medical history. Examination revealed typical erythema nodosum lesions on the legs, voluminous tender mass in the right breast. Bacteriological samples and tuberculosis test were negative. Imaging showed mastitis on the right breast with no evidence of malignancy. Histology revealed a non-caseating granulomas on the lobule of the right breast. As part of an etiological work-up, COVID-19 serology was performed with a positive IgG antibody. The diagnosis of IGM associated with erythema nodosum was evocated. The evolution was favorable under systemic corticosteroid therapy.Discussion: The cause of this uncommon lesion remains obscure. The extramammary localizations such as erythema nodosum and arthralgia suggest an autoimmune origin. This pathogenesis is also reinforced by a good response to systemic immunosuppression. In our patient, the etiological assessment of the mastitis revealed a chronic infection with SARS-CoV-2. Histopathology is the gold standard for the IGM diagnosis which demonstrates a lobulocentric granulomas without caseous necrosis. Oral corticosteroid therapy is the initial choice of treatment.Conclusion: Now, with several cases of concomitant IGM and EN reported, dermatologists should be aware that erythema nodosum can be one of the presenting signs of IGM, since the two conditions appear to be associated. The particularity of our case lies in the incidental discovery of SARS-CoV-2 infection. Is a chronic granulomatous disease associated with SARS-CoV-2 infection, a coincidence?Keywords: corticosteroid, erythema nodosum, granulomatous mastitis, Madagascar |
| first_indexed | 2024-04-10T04:13:11Z |
| format | Article |
| id | doaj.art-d1f3ab0b2c974ce1923ca96542b8ddc4 |
| institution | Directory Open Access Journal |
| issn | 1179-142X |
| language | English |
| last_indexed | 2024-04-10T04:13:11Z |
| publishDate | 2023-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Medical Case Reports Journal |
| spelling | doaj.art-d1f3ab0b2c974ce1923ca96542b8ddc42023-03-12T15:18:22ZengDove Medical PressInternational Medical Case Reports Journal1179-142X2023-03-01Volume 1615916582202Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy WomanRakotoarisaona MFRazafimaharo TIRazanakoto NHSendrasoa FADucournau ADevalland CDupond ASRanaivo IMRamarozatovo LSRapelanoro Rabenja FMendrika Fifaliana Rakotoarisaona,1 Tsiory Irintsoa Razafimaharo,1 Naina Harinjara Razanakoto,1 Fandresena Arilala Sendrasoa,1 Anne Ducournau,2 Christine Devalland,3 Anne-Sophie Dupond,2 Irina Mamisoa Ranaivo,4 Lala Soavina Ramarozatovo,1 Fahafahantsoa Rapelanoro Rabenja1 1Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar; 2Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France; 3Department of Pathology, Nord Franche-Comté Hospital, Trevenans, France; 4Department of Dermatology, University Hospital Morafeno, Toamasina, MadagascarCorrespondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Rue Dr Davioud Jacques, Antananarivo, 101, Madagascar, Tel/Fax +261 34 61947 34, Email lulubslj@gmail.comIntroduction: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Neoplastic and infectious etiologies must be ruled out. IGM is a diagnostic challenge for countries with high tuberculosis endemicity like Madagascar since it may clinically and radiologically mimic breast tuberculosis. We report a case of IGM associated with erythema nodosum in a Malagasy.Case Report: A 29-year-old primiparous woman came to a dermatological consultation for typical erythema nodosum lesions that appeared one month after a breast swelling. She had no particular medical history. Examination revealed typical erythema nodosum lesions on the legs, voluminous tender mass in the right breast. Bacteriological samples and tuberculosis test were negative. Imaging showed mastitis on the right breast with no evidence of malignancy. Histology revealed a non-caseating granulomas on the lobule of the right breast. As part of an etiological work-up, COVID-19 serology was performed with a positive IgG antibody. The diagnosis of IGM associated with erythema nodosum was evocated. The evolution was favorable under systemic corticosteroid therapy.Discussion: The cause of this uncommon lesion remains obscure. The extramammary localizations such as erythema nodosum and arthralgia suggest an autoimmune origin. This pathogenesis is also reinforced by a good response to systemic immunosuppression. In our patient, the etiological assessment of the mastitis revealed a chronic infection with SARS-CoV-2. Histopathology is the gold standard for the IGM diagnosis which demonstrates a lobulocentric granulomas without caseous necrosis. Oral corticosteroid therapy is the initial choice of treatment.Conclusion: Now, with several cases of concomitant IGM and EN reported, dermatologists should be aware that erythema nodosum can be one of the presenting signs of IGM, since the two conditions appear to be associated. The particularity of our case lies in the incidental discovery of SARS-CoV-2 infection. Is a chronic granulomatous disease associated with SARS-CoV-2 infection, a coincidence?Keywords: corticosteroid, erythema nodosum, granulomatous mastitis, Madagascarhttps://www.dovepress.com/idiopathic-granulomatous-mastitis-as-an-unusual-cause-of-erythema-nodo-peer-reviewed-fulltext-article-IMCRJcorticosteroiderythema nodosumgranulomatous mastitismadagascar |
| spellingShingle | Rakotoarisaona MF Razafimaharo TI Razanakoto NH Sendrasoa FA Ducournau A Devalland C Dupond AS Ranaivo IM Ramarozatovo LS Rapelanoro Rabenja F Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman International Medical Case Reports Journal corticosteroid erythema nodosum granulomatous mastitis madagascar |
| title | Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman |
| title_full | Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman |
| title_fullStr | Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman |
| title_full_unstemmed | Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman |
| title_short | Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman |
| title_sort | idiopathic granulomatous mastitis as an unusual cause of erythema nodosum in a malagasy woman |
| topic | corticosteroid erythema nodosum granulomatous mastitis madagascar |
| url | https://www.dovepress.com/idiopathic-granulomatous-mastitis-as-an-unusual-cause-of-erythema-nodo-peer-reviewed-fulltext-article-IMCRJ |
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