Lupus mastitis and antiphospholipid syndrome treated with anticoagulation and immunosuppression: a case report

Journal of Medical Case Reports

Case Report

Lauren J. He¹  Oluwakemi Onajin²  Kimberly C. Trotter³  Laarni C. Quimson³ 

[1] Department of Medicine, University of Chicago Medical Center, 1000 E. 53rd St, Apt 412S, 60615, Chicago, IL, USA;Section of Dermatology, University of Chicago, Chicago, IL, USA;Section of Rheumatology, University of Chicago, Chicago, IL, USA;

关键词: Lupus mastitis;    Antiphospholipid syndrome;    Breast lesion;    Case report;    Lupus erythematosus panniculitis;   

DOI  :  10.1186/s13256-023-04054-1

 received in 2023-02-12, accepted in 2023-06-23,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSystemic lupus erythematosus is an autoimmune disease that can have cutaneous and systemic manifestations. Lupus panniculitis, also known as lupus mastitis, is a subset of chronic cutaneous lupus erythematosus that involves inflammation of the subcutaneous fat. The pathogenesis of lupus mastitis is not fully understood. Diagnosis involves a combination of skin manifestations, imaging, and pathologic confirmation. Treatment typically includes steroids and antimalarials, with more severe disease requiring additional immunosuppressive medications. This report highlights a case of lupus mastitis treated with rituximab and a possible relationship between this disease process and thrombotic disease.Case presentationA 48-year-old African American female with systemic lupus erythematosus and antiphospholipid syndrome presented with new breast lesion. Mammography revealed calcifications and increased density with coarse trabecular pattern. Breast biopsy showed features of cutaneous lupus and occlusive vasculopathy. The patient was diagnosed with lupus mastitis and treated with anticoagulation, rituximab, mycophenolate mofetil, and quinacrine with resolution of her symptoms.ConclusionThis patient experienced improvement in her breast symptoms with combination therapy including rituximab. There are only two other cases reported in literature of patients with lupus mastitis responding to rituximab, highlighting the possible role of B cell depleting therapy for those who have contraindications to standard treatments for lupus mastitis. While the pathophysiology of lupus mastitis is thought to be immune driven, some literature suggests that associated thrombosis commonly seen may be due to a physiologic overlap similar to antiphospholipid syndrome. The possible relationship between antiphospholipid syndrome and lupus mastitis and the use of antiplatelet and anticoagulation therapy is discussed and may warrant further investigation.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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