A case management model for patients with granulomatous mastitis: a prospective study

Abstract

Background Granulomatous mastitis (GM) is a chronic inflammatory mastitis disease that requires long-term treatment and has a high recurrence rate. Case management has been proven to be an effective mechanism in assisting patients with chronic illness to receive regular and targeted disease monitoring and health care service. The aim of this study was to investigate the application of a hospital-to-community model of case management for granulomatous mastitis and explore the related factors associated with its recurrence. Methods This was a prospective study on patients with granulomatous mastitis based on a case management model. Data on demographic, clinical and laboratory information, treatment methods, follow-up time, and recurrence were collected and analyzed. The eight-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate patients' adherence to medications. Logistic regression models were built for analysis of risk factors for the recurrence of granulomatous mastitis. Results By October 2021, a total of 152 female patients with a mean age of 32 years had undergone the entire case management process. The mean total course of case management was 24.54 (range 15–45) months. Almost all the patients received medication treatment, except for one pregnant patient who received observation therapy, and approximately 53.9% of the patients received medication and surgery. The overall recurrence rate was 11.2%, and “high” medication adherence (RR = 0.428, 95% CI 0.224–0.867, P = 0.015) was significantly associated with a lower rate of recurrence, while the rate of recurrence with a surgical procedure + medication was higher than that with medication alone (RR = 4.128, 95% CI 1.026–16.610, P = 0.046). Conclusion A case management model for patients with granulomatous mastitis was applied to effectively monitor changes in the disease and to identify factors associated with disease recurrence. “Low” medication adherence was a significant risk factor for the recurrence of granulomatous mastitis. Patients treated with medication and surgery were more likely to experience recurrence than those treated with medication alone. The optimal treatment approach should be planned for granulomatous mastitis patients, and patient medication adherence should be of concern to medical staff.

Identification of periductal mastitis and granulomatous lobular mastitis: a literature review

“…The pathological changes of GLM center around the breast lobule, and its mechanism may be increased milk secretion followed by siltation to destroy the structure of breast lobules and ducts. Secretion overflow into the stroma can induce local immune reactions and lead to granuloma formation (53). A previous study (54) showed that there was a higher rate of breastfeeding in patients with GLM and that breastfeeding mothers took longer to relieve symptoms than those who did not breastfeed.…”

Granulomatous mastitis in accessory breast tissue: A rare presentation and surgical management

“…It is a serious condition, since it clinically mimics cancer ( 6 ). Ethnic diversity has a role in the distribution of this condition, as GM occurrences are more prevalent in Middle Eastern nations compared to Western countries ( 7 ). GM in accessory breast tissue is rare.…”

Clinical characteristics and therapeutic strategy of granulomatous mastitis accompanied by Corynebacterium kroppenstedtii: a retrospective cohort study

“…Recently, GM has become increasingly prevalent in China [ 6 ]. Its clinical presentation can be variable, ranging from acute infective episodes such as abscess or mastitis to breast lump resembling malignancy [ 5 , 7 , 8 ]. Sometimes, erythema nodosum and arthritis occur as extramammary presentations of GM [ 9 ].…”