Bilateral Lupus Mastitis During Pregnancy

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A 30-year-old woman presented with inflammatory polyarthritis, diffuse alopecia, discoid rash, and purpuric rash in both lower limbs for 1 year. She also has a history of recurrent abortions (gravida 4, para 1, alive 0, abortion 3) in 8 years of marriage. Her investigation revealed antinuclear antibody, double-stranded DNA, and Ro and La positivity, along with hypergammaglobulinemia (workup of antiphospholipid antibody syndrome was negative). She was diagnosed as having systemic lupus erythematosus and was administered low-dose steroid, hydroxychloroquine, and aspirin. After 3 months, she conceived, and heparin was also added (as advised by the gynecologist). In the 10th week of pregnancy, she developed bilateral breast swelling, pain, and redness (Fig.). On examination, the breasts appeared inflamed, tender, and warm to palpation. Initially, she was treated with multiple courses of antibiotics without any improvement. Based on clinical presentation, possibility of bilateral lupus mastitis was considered, and her dose of prednisolone was increased to 0.5 mg/kg, to which there was complete resolution. Her subsequent period of pregnancy was uneventful, and she delivered a baby girl at 9 months. Lupus profundus (also known as lupus panniculitis) is an uncommon form of chronic cutaneous lupus erythematosus. Coexistent discoid lupus erythematosus occurs in at least one third of patients with lupus profundus; systemic lupus erythematosus is present in approximately 10% of patients.1,2 Lupus mastitis is a rare presentation of lupus panniculitis involving the deep subcutaneous adipose tissue of the breast.3,4 This is the first case in literature to describe bilateral lupus mastitis during pregnancy, as part of lupus flare.
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