Abstract
A 37-year-old women suffered a contusion to the left side of her chest while playing with her toddler 2 weeks prior to presentation. She then noticed swelling, redness, and induration of her entire left breast. She also had painful red nodules on both legs and palms and was evaluated at our clinic. CT and MRI showed early and persistent contrast enhancement of the entire left breast, but without evidence of a tumor.
The patient was diagnosed with acute mastitis and erythema nodosum, antibiotics and prednisolone were started, and the fever resolved rapidly with improvement in the erythematous nodules. However, fever again developed 2 days after completing treatment, and prednisolone was resumed. Drainage was performed for a well-demarcated abscess in the left breast. Aspiration biopsy showed an epithelioid cell granuloma with marked lymphocytic infiltration and multinucleated giant cells. The diagnosis was granulomatous mastitis.
Incision and drainage were required even after prednisolone was tapered and discontinued. Fever has not recurred during 7 months of follow-up. Granulomatous mastitis with erythema nodosum in a patient with a chest contusion has not previously been reported in Japan. This case is reported along with a discussion of the relevant literature.
