Diffuse Dermal Angiomatosis of the Breast Presenting as Diffuse Erythema Mimicking Inflammatory Breast Carcinoma in a Healthy Pregnant Patient

Diffuse dermal angiomatosis represents a reactive form of microvascular proliferation characteristically linked with vascular insufficiency of diverse etiology. It occurs most commonly on the lower extremity where a frequent association is venous insufficiency; however, it can exhibit breast localization falling under the designation of diffuse dermal angiomatosis of the breast (DDAB). The clinical presentation of DDAB can be striking and resembles a catastrophic thrombogenic vasculopathy such as purpura fulminans, calciphylaxis, and antiphospholipid antibody syndrome. However, a less common presentation is one of diffuse erythema mimicking inflammatory breast carcinoma as the main clinical presentation. Most articles devoted to the topic of DDAB describe a reproducible association with diseases and/or other risk factors such as smoking that can result in microvascular insufficiency. In contradistinction, the development of this reactive vascular process in a healthy patient would be considered exceptionally uncommon, albeit it has been reported. We describe a case of bilateral DDAB in a patient who was 21 weeks pregnant; the clinical diagnosis was inflammatory breast carcinoma. The case was unusual for three primary reasons: the age of the patient, the lack of any history of vascular insufficiency, and the clinical presentation resembling inflammatory breast carcinoma. Although the downstream effects eventuated in dermal angiomatosis, the upstream mechanisms were clearly different than what is implicated in conventional DDAB. The pathophysiology as it applies to this case is explored. Our patient serves to expand the clinical and pathophysiologic spectrum of DDAB .