Rationale: This case report describes a rare and severe presentation of post-traumatic eczema that clinically mimics mammary Paget disease. The case is uniquely significant due to its striking, “bark-like” hyperkeratotic appearance. This severity resulted from a combination of diagnostic delay and iatrogenic factors, specifically, prolonged, unsupervised postoperative application of povidone-iodine in a vulnerable elderly patient. This highlights the diagnostic challenge of differentiating between benign and malignant eczematous breast lesions. Patient concerns: An 81-year-old female with limited mobility developed a severe, crusted, lichenified eczematous lesion in her left breast following a surgical procedure. The condition persisted for 6 months without a correct diagnosis, resulting in a markedly severe presentation. Diagnoses: The initial clinical differential diagnosis was mammary Paget disease. However, histopathological examination confirmed a definitive diagnosis of post-traumatic eczema with a clear iatrogenic link to prolonged contact with povidone-iodine. Interventions: The patient was treated with topical corticosteroids and an oral antihistamine. Outcomes: The patient responded well to treatment, with complete resolution of the skin lesion. At the 1-year follow-up, there were no signs of recurrence. Lessons: This case underscores the critical importance of histopathology in differentiating inflammatory dermatoses of the breast from malignancies, as the clinical appearance can be highly misleading. Furthermore, it serves as a crucial cautionary example of the need for diligent and appropriate postoperative wound care management, particularly in vulnerable patient populations, to prevent severe iatrogenic complications.
Yao et al. (Fri,) studied this question.