Granulomatous Mastitis Complicated by Arthralgia and Erythema Nodosum Successfully Treated with Prednisolone and Methotrexate

Abstract

A 23-year-old woman was admitted with complaints of swelling and pain in the left breast, fever, polyarthralgia and erythema nodosum. A fine-needle biopsy of the mass in the left breast revealed non-caseous granulomatous lobulitis. A diagnosis of granulomatous mastitis was thus made. The administration of prednisolone 40 mg/day resulted in the resolution of the patient's symptoms, and the breast mass thereafter decreased in size. The mass relapsed during the subsequent prednisolone taper. Additional therapy with methotrexate resulted in complete remission. Granulomatous mastitis should therefore be included in the differential diagnosis of polyarthralgia.

Strategies to treat idiopathic granulomatous mastitis: Retrospective analysis of 40 patients

“…Only 9 cases with erythema nodosum coexisting with GM have been reported in literature. Complete remission via combining the steroid regimen with methotrexate treatment so as to minimize the resistence against the steroids, have been shown in literature [16]. This supports the hypothesis suggesting that IGM might be an autoimmune disease.…”

“…Granulomatous mastitis was first described by Kessler and Wolloch in 1972 and comprises 24% of all inflammatory breast diseases [15,16]. This disease is characterized by exacerbations and remissions requiring long term treatment and follow-up period.…”

Idiopathic Granulomatous Mastitis Associated with Erythema Nodosum

“…The diagnosis of IGM is based on the exclusion of other granulomatous diseases, such as tuberculosis, sarcoidosis, Wegener's granulomatosis and connective tissue disorders. In our patient, the negative laboratory results and lack of other clinical features of that spectrum of diseases supported the differential diagnosis (3,4,6).…”

An Unusual Cause of Oligoarthritis and Erythema Nodosum: Idiopathic Granulomatous Mastitis

“…[4][5][6][7][8][9][10] Two of these reports were associated with pregnancy and lesions had appeared in third trimester. 4,5 Arthritis accompanying IGM regresses concurrently with resolution of IGM, which suggests that arthritis in these cases was the result of a reactive process.…”

“…3 It has been rarely associated with oligoarthritis and erythema nodosum (EN) in the literature. [4][5][6][7][8][9][10] In this article, we discuss the diagnostic, clinical, and therapeutic approach to a unique case with granulomatous mastitis, EN, and arthritis that may be of interest to clinicians who are not readily familiar with this condition.…”