Idiopathic Granulomatous Mastitis Associated with Erythema Nodosum

Abstract

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with indrawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrastenhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones.

Idiopathic granulomatous mastitis with erythema nodosum: Is it a variant of clinical presentation indicating treatment resistance? A retrospective cohort study

“…8 The EN and IGM association is rare, reported with case reports and series. [9][10][11][12][13][14][15] Additionally, to the best of our knowledge, it is the only systemic and extra-breast finding of IGM. However, no studies were reported before elaborating the significance of both entities' coexistence on the severity of IGM and response to conventional treatment.…”

Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment

“…The disease, was first described by Kessler and Wollock in 1972 ( 5 ). Although it is a benign condition, it is important from different points of view: 1-it poses a diagnostic and treatment dilemma ( 2 , 3 ), also, it clinically and mammographically mimics breast cancer, especially inflammatory type ( 4 ). On the other hand, due to lack of a definitive treatment plan, complications of empiric treatment, such as allergic reaction to antibiotics and poor cosmetic procedures result in following repeated surgical interventions which threaten the patients ( 2 , 4 ).…”

A Retrospective Study of Idiopathic Granulomatous Mastitis at a Tertiary Care Center

“…Idiopathic granulomatous mastitis is a rare benign chronic inflammatory disease of breast that involves mainly women of childbearing age. 1,2,3,4 The disease, was first described by Kessler and Wollock in 1972. 5 The etiopathogenesis of IGM is unknown but some factors causing reaction to chemical materials such as OCP, infectious disease, autoimmune diseases and immunologic response for milk leakage from the breast's lobule.…”

“…5 The etiopathogenesis of IGM is unknown but some factors causing reaction to chemical materials such as OCP, infectious disease, autoimmune diseases and immunologic response for milk leakage from the breast's lobule. 3,6 Also conditions like pregnancy, breast feeding, hyperprolactinemia, galactorrhoea, and alpha 1 antitrypsin deficiency have been associated with the risk of the disease. Most common clinical features are breast mass, pain, skin changes, axillary lymphadenopathy, inflammation may not always be present clinically, thus leading to misdiagnosis as a malignant lesion.…”