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Case Reports
. 2021 Aug 20:2021:4416072.
doi: 10.1155/2021/4416072. eCollection 2021.

A Case of Granulomatosis with Polyangiitis with Various Breast Lesions as the Initial Symptoms: A Case-Based Review

Masatoshi Kawataka  1 , Toshiki Kido  1 , Reina Tsuda  1 , Takafumi Onose  1 , Ryoko Asano  1 , Miho Yamazaki  1 , Naonori Sugishita  1 , Hiroyuki Hounoki  1 , Toshiko Kakiuchi  2 , Koichiro Shinoda  1 , Kazuyuki Tobe  1
Affiliations
Case Reports

A Case of Granulomatosis with Polyangiitis with Various Breast Lesions as the Initial Symptoms: A Case-Based Review

Masatoshi Kawataka et al. Case Rep Rheumatol. .

Abstract

A 44-year-old woman presenting with pus-like discharge from the nipples visited our hospital for scleritis. Subcutaneous induration and ulceration were found on her breast. She was diagnosed with granulomatosis with polyangiitis (GPA) considering scleritis, sinusitis, cutaneous granuloma formation, and antiproteinase 3-antineutrophil cytoplasmic antibodies and was successfully treated with glucocorticoids. Fifteen months later, she developed pulmonary consolidation and a right breast nodule. Biopsies of the breast nodule showed granulomatous vasculitis, and she was treated with rituximab. While breast involvement in GPA is rare, unilateral breast mass is a typical clinical feature; thus, GPA should be considered in such cases.

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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Figures

Figure 1
Figure 1
(a) Clinical pictures of the patient's bilateral necrotizing scleritis. (b) Discharge from her nipples (arrow). (c) Pale erythema (arrowhead) and a skin ulcer (arrow) on the right breast.
Figure 2
Figure 2
(a) Computed tomography showing tumor-like lesions in the patient's breasts (right, arrowhead; left, arrow) on the first admission. (b) Whole-body computed tomography revealing pulmonary consolidation in the right lower lobe (circle). (c) A small nodule in the right breast (arrow), and (d) recurrence of right maxillary sinusitis (arrow) during the second admission.
Figure 3
Figure 3
Mediolateral oblique (a, b) and craniocaudal (c, d) mammography demonstrates a round, microlobulated, and high-density mass lesion in the right breast (a, c) and circumscribed, round, and high-density mass lesion in the left breast (b, d).
Figure 4
Figure 4
Histopathological findings of the biopsy of the nodule in the right breast. Lymphocyte-dominant inflammatory cell infiltration and granulomas with polynuclear giant cells (arrow) are visible around the blood vessels in the subcutaneous fat layer with hematoxylin and eosin staining (a). Verhoeff's Van Gieson staining shows destruction of the elastic plate (b) (arrowheads).
See this image and copyright information in PMC

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