Methotrexate in the Management of Idiopathic Granulomatous Mastitis: Review of 108 Published Cases and Report of Four Cases

Akbulut, Sami; Yilmaz, Davut; Bakir, Sule

doi:10.1111/j.1524-4741.2011.01162.x

Cited by 106 publications

(96 citation statements)

References 47 publications

(172 reference statements)

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“…However, the granulomatous mastitis relapsed when the dose of prednisolone was tapered to 15 mg/day. It has been reported that a low weekly dose of MTX may be effective in cases with resistance to corticosteroids (5,12). Therefore, MTX was added to the patient's therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Nakamura

Yoshioka²,

Miyashita

et al. 2012

Intern. Med.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Nakamura

Yoshioka²,

Miyashita

et al. 2012

Intern. Med.

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“…Corticosteroid therapy in IGM is increasingly used (26)(27)(28). Further studies looking into the impact of immunomodulator treatment in cases of granulomatous breast infections are needed, with particular caution if combined with an antimicrobial regime that includes rifampin (29).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species

et al. 2015

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cCorynebacterium species are increasingly recognized as important pathogens in granulomatous mastitis. Currently, there are no published treatment protocols for Corynebacterium breast infections. This study describes antimicrobial treatment options in the context of other management strategies used for granulomatous mastitis. Corynebacterium spp. isolated from breast tissue and aspirate samples stored from 2002 to 2013 were identified and determined to the species level using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), 16S RNA sequencing, and rpoB gene targets. The MICs for 12 antimicrobials were performed using Etest for each isolate. Correlations of these with antimicrobial characteristics, choice of antimicrobial, and disease outcome were evaluated. Corynebacterium spp. from breast tissue and aspirate samples were confirmed in 17 isolates from 16 patients. Based on EUCAST breakpoints, Corynebacterium kroppenstedtii isolates (n ‫؍‬ 11) were susceptible to seven antibiotic classes but resistant to ␤-lactam antibiotics. Corynebacterium tuberculostearicum isolates (n ‫؍‬ 4) were multidrug resistant. Two nonlipophilic species were isolated, Corynebacterium glucuronolyticum and Corynebacterium freneyi, both of which have various susceptibilities to antimicrobial agents. Short-course antimicrobial therapy was common (median, 6 courses per subject; range, 1 to 9 courses). Patients with C. kroppenstedtii presented with a hot painful breast mass and underwent multiple surgical procedures (median, 4 procedures; range, 2 to 6 procedures). The management of Corynebacterium breast infections requires a multidisciplinary approach and includes culture and appropriate sensitivity testing to guide antimicrobial therapy. Established infections have a poor outcome, possibly because adequate concentrations of some drugs will be difficult to achieve in lipophilic granulomata. Lipophilic antimicrobial therapy may offer a therapeutic advantage. The role of immunotherapy has not been defined. Granulomatous mastitis (GM) is a rare inflammatory condition that typically occurs in parous women of reproductive age (1). Clinically, it can present as a breast mass with features similar to those of breast malignancy (2). Multiple infective and inflammatory conditions, including tuberculosis (TB), fungal infections, sarcoidosis, amyloidosis, and Wegener's granulomatosis, have been recognized, but recently, attention has been drawn to corynebacterial species as a specific pathogen in this disease. Typically, corynebacterial breast infections are characterized by abscess formation, granulomatous inflammation, and progression to sinus/fistula formation (3). This and other specific diagnoses should be excluded before a diagnosis of idiopathic granulomatous mastitis (IGM) is made (3-5).Commonly, it is the lipophilic species of the Corynebacterium genus that cause mastitis (3, 6-8). As such, a microbiological diagnosis can be challenging, due to their fastidious growth requirements and prolonged incu...

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“…Several other reports of using 60 mg/kg/day prednisolone to treat IGM have also been published. However, in the literature the recommended dose ranges between 0.5 and 2 mg/kg/day (11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

The effect of corticosteroid treatment on bilateral idiopathic granulomatous mastitis

2017

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Idiopathic granulomatous mastitis (IGM) is the commonly encountered form of granulomatous mastitis that may result into repetitive infections and/or abscess formation. Mastitis may develop secondary to a systemic disorder such as tuberculosis, diabetes mellitus, or rheumatoid arthritis, or it may develop as an idiopathic disorder. Idiopathic granulomatous mastitis is the most frequent form of all granulomatous diseases affecting the breast. This disorder frequently presents as painful and fast-growing mass in the breast. Biopsy is required to confirm diagnosis. Surgical excision and immunosuppressive treatment with corticosteroids are employed for therapeutic management. Here we present 3 female cases of bilateral IGM who were followed up and treated successfully with 1 mg/kg/day prednisolone.

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Methotrexate in the Management of Idiopathic Granulomatous Mastitis: Review of 108 Published Cases and Report of Four Cases

Cited by 106 publications

References 47 publications

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

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

Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species

The effect of corticosteroid treatment on bilateral idiopathic granulomatous mastitis

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