# Breast Gangrene Associated With Thrombotic Vasculopathy: A Case Report

## TL;DR

A 50-year-old woman with rheumatoid arthritis developed rare breast gangrene due to blood vessel blockage, which responded to treatment but was not fully followed up.

## Contribution

This case report is the first to associate breast gangrene with thrombotic vasculopathy in the context of rheumatoid arthritis.

## Key findings

- Breast gangrene was diagnosed due to thrombotic vasculopathy in a patient with rheumatoid arthritis.
- The patient showed improvement with prednisone and methotrexate but was lost to follow-up.
- Breast gangrene is rare and often linked to severe infections or autoimmune conditions, but this is the first report of its association with thrombotic vasculopathy.

## Abstract

This article aimed to report a patient with breast gangrene secondary to occlusive thrombotic vasculopathy. A 50-year-old woman with a history of long-standing rheumatoid arthritis presented with a rapidly progressing necrotic ulcer on her right breast. Tests showed active rheumatoid arthritis. Biopsy revealed epidermal necrosis and thrombotic vasculopathy with fibrinous thrombi. The patient was diagnosed with breast gangrene secondary to thrombotic vasculopathy associated with rheumatoid arthritis. Prednisone and methotrexate were initiated with a favorable response, but the patient was subsequently lost to follow-up. Breast gangrene is a rare and potentially life-threatening condition, most commonly associated with necrotizing fasciitis and favored by severe infections, microangiopathy, multiple comorbidities, trauma, iatrogenic procedures, immunosuppression, and idiopathic forms. Management relies on prompt surgical debridement and broad-spectrum antibiotic therapy; in extensive cases, reconstructive surgery or mastectomy may be required due to the condition's high morbidity and mortality. Although it has been linked to other autoimmune diseases, an association with thrombotic vasculopathy has not been previously reported.