Clinical Characteristics and Medical Management of Idiopathic Granulomatous Mastitis

Abstract

Conflict of Interest Disclosures: Dr Pomeranz reported being a paid member of the scientific advisory board of Procter & Gamble and receiving royalties from UpToDate. Dr Femia reported receiving royalties from UpToDate. No other disclosures were reported.

Idiopathic Granulomatous Mastitis Presenting in a Patient With Hypothyroidism and Recent Hospitalization for Myxedema Coma: A Rare Case Report and Review of Literature

“…Methotrexate appeared to be a successful second-line therapy in patients with doxycycline-refractory disease (complete response in 50%). 2 Additional immunosuppressant therapies remain under investigation and may offer promising results in the future. 6 Oftentimes multiple surgical debridement procedures are performed and are usually unsuccessful due to disease recurrence.…”

“…The disease is often confused with more common conditions such as bacterial abscesses and malignancies, and as such, successful diagnosis relies on a high index of suspicion and clinical gestalt. 1,2 Oftentimes patients receive multiple courses of antibiotics, biopsies, and unnecessary surgical procedures due to the challenge in diagnosis. Clinical features, inflammatory markers, negative wound cultures, and tissue analysis are used together to make the diagnosis.…”

“…The disease is often seen in women of child-bearing age and a higher incidence has been seen among Hispanic women. 2 The pathogenesis of IGM remains unclear, although there is increasing evidence in support of an autoimmune mechanism that has been attributed to environmental triggers, infection, and trauma. 3,4 High prolactin levels have also been associated with the disease.…”

Granulomatosis with polyangiitis: a life‐threatening cause of granulomatous mastitis

“…Idiopathic granulomatous mastitis is an increasingly recognized, albeit rare, entity that can mimic breast malignancies and abscesses. 1 The pathogenesis is poorly understood, currently conceptualized as an autoimmune reaction to milk proteins within interstitial breast tissue. 2 Supporting this hypothesis, it presents as a mass with variable pain, erythema or discharge, typically in women of child-bearing age who have a recent history of pregnancy and lactation.…”

“…2 Supporting this hypothesis, it presents as a mass with variable pain, erythema or discharge, typically in women of child-bearing age who have a recent history of pregnancy and lactation. 1,3,4 The histologic pattern of lobulocentric granulomatous inflammation can also be observed in malignancies, infections and autoimmune conditions. Thus, idiopathic granulomatous mastitis must remain a diagnosis of exclusion, especially in women who are nulliparous or post-menopausal.…”