Idiopathic Granulomatous Mastitis: A Rare Confrontation

Abstract

Idiopathic granulomatous mastitis is a benign chronic inflammatory condition of the breast, the etiology of which has not been identified yet; it mimics two common breast disorders: breast carcinoma and tuberculous mastitis. Hence, this clinical entity poses difficulties in the diagnostic work-up. As clinical presentation and imaging findings often simulate other infectious and neoplastic etiologies, an accurate and early diagnosis is crucial to prevent misdiagnosis. Clear guidelines have yet to be established regarding treatment. In this report, we describe a case in which a patient presented with a painful breast mass and was diagnosed with idiopathic granulomatous mastitis after histological evaluation. We managed this patient with a combination of surgical excision and, subsequently, a course of antibiotics and steroids. To conclude, idiopathic granulomatous mastitis must be considered a possible differential while treating a patient with a lump in the breast tissue.

Recurrent Idiopathic Granulomatous Mastitis: A Case Report

“…Idiopathic granulomatous mastitis is a rare benign chronic inflammatory condition of the breast that often masquerades as other common conditions like breast abscess, tuberculosis, and breast cancer. 5 The condition is most common in women of childbearing age. 5 There are several risk factors like oral contraceptives, autoimmunity, infectious causes, and milk spillage from breast lobules.…”

“… 5 The condition is most common in women of childbearing age. 5 There are several risk factors like oral contraceptives, autoimmunity, infectious causes, and milk spillage from breast lobules. 3 , 6 As there is vague clinical presentation which poses a great challenge for diagnosis.…”

“…It may initially present as breast pain, erythema, induration, lump, ulceration, fistula, and nipple retractions. 5 …”

“…Sometimes the presentation of the disease can mimic breast cancer when they present with features of nipple retraction. 5 It poses a great burden of morbidity due to difficulty in diagnosis and treatment as this female had undergone multiple incision and drainage procedures with antibiotics suspecting it a breast abscess but she did not respond to the treatment.…”

“… 4 Often medical management includes high doses of steroids and antibiotics, as the patient was initially given a trial of systemic steroid with antibiotics but she did not respond to it. 5 However, literature reviews show that wide surgical excision, corticosteroids, methotrexate, azathioprine, and colchicine can be used for treatment. 3 , 7 Treatment depends on the severity of the disease and may include observation, systemic steroids, broad-spectrum antibiotics or surgery.…”