Pyoderma gangraenosum in a lactating breast
Jakubowski P.1, Röhm C.1, Böer B.1, Fugunt R.1, Thiel L.1, Gürgan S.1, Hoopmann U.1, Hahn M.1
1Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland

A 32-year-old women was admitted 8 weeks postpartum with diarrhea und hematochezia. Simultaneously she developed an extremely painful mass in her right breast. Initial diagnosis was a lactational mastitis with an abscess and skin necrosis. A scheduled colonoscopy could not be performed due to massive pain in the right breast. An antibiotic treatment was initiated at admission. A surgical incision and drainage of the mass was performed, followed by daily rinsing of the wound. E. coli was found in the microbiological examination and antibiotics were adapted according to the antibiogram. After five days of daily rinsing, the wound further progressed and irregular purple edge showed, so that we initiated negative pressure wound therapy (NPWT). After reevaluating the case pyoderma gangraenosum (PG) was diagnosed. PG is a neutrophilic dermatosis, often associated with inflammatory bowel disease. Pathergy is a common feature of PG and could be explained by the patient breast feeding in this case. A CT-scan showed a pancolitis and a subsequent colonoscopy confirmed ulcerative colitis. A therapy with steroids and Adalimumab was initiated, which resulted in a quick reduction of pain and good healing of the wound, so that the NPWT was discontinued after seven days. Secondary wound healing under continuation of the anti-inflammatory therapy was completed after 6 months.
This case illustrates the close association between pyodarma gangraenosum and chronic inflammatory bowel diseas, as well as pathergy in PG. Unitil now, there are no other reported cases of PG in a lactating breast treated with NPWT.