Pyoderma Gangrenosum of the Breast: A Rare and Challenging Diagnosis

Background: Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis characterized by rapidly progressive, painful ulceration, often associated with systemic diseases and triggered by trauma or surgery. Breast involvement is exceptionally uncommon, posing significant diagnostic challenges due to mimicry of infectious or malignant processes. Case presentation A 61-year-old postmenopausal woman (G5P5) with controlled type 2 diabetes presented with fever and a rapidly enlarging, painful ulcer on the right breast, progressing from a 1 cm pustule to an 8 × 5 cm lesion over one week despite oral antibiotics (Figure 1). Ultrasound revealed diffuse skin thickening without abscess (Figure 2). Negative cultures prompted surgical debridement and biopsy, which confirmed PG with necrotizing vasculitis and lymphoplasmacytic infiltration (Figure 3). Treatment with systemic corticosteroids (1 mg/kg prednisolone) led to complete healing within two months. Conclusion Breast PG requires high clinical suspicion to avoid unnecessary surgery. Early immunosuppressive therapy is crucial for optimal outcomes and preservation of breast aesthetics.