History: A 61 year-old African American woman presented with a 6 month history of painful ulcerations on the breasts. The initial ulceration on the left breast had progressed in size over time and had become progressively more tender. More recently, similar smaller ulcerations began to form on the right breast. No fevers, chills, malaise; no history of similar eruptions in the past.
Past Medical History: hypertension, hyperlipidemia, osteoarthritis, GERD
Social History: Patient is retired. She smokes 1/3 pack of cigarettes per day, no alcohol use.
Family History: Diabetes mellitus, hypertension, hyperlipidemia
Medications: amlodipine, carvedilol, losartan, omeprazole, simvastatin, spironolactone
Physical Exam: Obese AAF in no apparent distress with exquisitely tender retiform violaceous non-blanching patches on bilateral breasts with central shallow ulcerations (Figures 1 and 2).
Laboratory Results: CBC, CMP, ESR normal. CRP 0.72, ANA weakly positive (1:80, speckled), ANCA negative. Antithrombin, protein C and protein S activity normal, Factor V Leiden negative. Lupus anticoagulant negative, antiphospholipid antibodies negative.
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