History: 54 yo AAF with an enlarging tumor on her left breast for 4 months that is painful, oozing and affecting her quality of life. She initially received a 6-week prednisone taper (60 mg po qd x 2 weeks, 40 mg po qd x 2 weeks, 20 mg po qd x 2 weeks) and dapsone 50 mg po qd which was increased to 100 mg po qd two months into treatment because of a lack of improvement. One milliliter of intralesional kenalog 20 mg/cc was injected into the periphery of the lesion without improvement as well. Of note, she had similar lesions on her abdomen in 2009 and on her suprapubic area in 2010. 


Past Medical History: Type 2 diabetes mellitus

Family Hx: Noncontributory

Allergies: None

Medications: Humalog


Physical Exam: ~6 x 4 cm vegetative tumor with oozing on left breast surrounding superior half of areola (Fig.1). There were hypopigmented patches on lower abdomen and suprapubic areas at sites of prior disease


Laboratory findings: Hct 35 (slightly low), Magnesium, uric acid, CMP, TPMT, Hepatitis B and C, HIV were negative

Bacterial gram stain: negative

Aerobic culture: mixed microorganisms, few streptococcus dysgalactase (Group C strep), few staphylococcus aureus

Fungal culture: negative


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