Sequelae of breast pyoderma gangrenosum associated with ulcerative colitis: Impact on breast cancer screening

Abstract

A 56‐year‐old woman was referred to biennial breast cancer screening (BCS). Her previous mammograms were normal. She had a history of arterial hypertension. Six years earlier, she had undergone clipping of posterior communicating artery aneurysm. Four years earlier, she was diagnosed with ulcerative colitis (UC). One and a half years ago, a dramatic exacerbation of UC occurred. Concomitantly, painful, necrotic skin ulcers developed on the left breast, right thigh, and infraumbilical region. The coexisting UC, histological findings and negative blood and wound cultures con‐ firmed the diagnosis of pyoderma gangrenosum (PG). The remis‐ sion of UC and PG were achieved after 3 months of treatment with high doses of corticosteroids, escalation of therapy for UC and traditional skin ulcers care to avoid pathergy. A physical examina‐ tion revealed a retracted, firm left breast, with an atrophic, crib‐ riform scar (Figure 1). Full‐field digital mammogram (FFDM) was inconclusive (Figure 2A,B). Dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) revealed sequelae of fat necrosis, F I G U R E 1 Digital photograph shows a “cigarette paper‐like” scar on the left breast, with typical sparing of nipple/areola complex