Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature

Abstract

Idiopathic granulomatous mastitis (IGM) is a benign persistent inflammatory breast entity characterized histologically by lobulo centric granulomas. Diagnosis may be difficult and involves a strong index of suspicion. There are plentiful studies are published which render the disease more frequently than expected. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Patients have an excellent prognosis when they are appropriately treated. The management remains contentious, good judgment is required to ensure optimum treatment form and timing.

Eosinophilic mastitis: a rare benign inflammatory condition and review of the literature

“…When present, it is often related to conditions such as idiopathic granulomatous mastitis (IGM) [ 6 , 7 ], secondary to infection [ 8–10 ] or associated with systemic vascular disease such as Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome) [ 11–13 ]. In these conditions, the eosinophilic infiltration is usually accompanied by lymphocytes, epithelial histocytes or Langerhan’s giant cells on a neutrophilic background, and often self-limited to the lobules of the breast rather than periductal [ 6 , 14 , 15 ]. In the rare case of eosinophilic mastitis, eosinophils comprise the main infiltrate in sampled inflammatory tissue and there is an absence of an alternative inflammatory process such as granulomatous inflammation, vasculitis or infection.…”

Principles of empiric antimicrobial usage and dosing: Lessons learned

“…3 Multiple antimicrobials including clindamycin, metronidazole, linezolid, fluoroquinolones, tetracyclines, rifampin, trimethoprim/sulfamethoxazole, and triazole antifungals have an oral bioavailability in excess of 90%. 1 The benefits of employing a highly bioavailable oral agent over its intravenous counterpart include decreased time needed for preparation and administration, reduction in intravenous line-associated complications (including infections and thrombophlebitis), decreased cost of health professionals needed to administer the drug, and early discharge from a treatment facility. 4 By utilizing intravenous clindamycin, our patient was required to attend the hospital daily, a relevant impediment to her ability to attend work and generate income, particularly when an oral equivalent was available.…”

“…Blood and target tissue concentrations are equivalent when using a highly bioavailable oral antibiotic agent compared with its intravenous counterpart 3 . Multiple antimicrobials including clindamycin, metronidazole, linezolid, fluoroquinolones, tetracyclines, rifampin, trimethoprim/sulfamethoxazole, and triazole antifungals have an oral bioavailability in excess of 90% 1 . The benefits of employing a highly bioavailable oral agent over its intravenous counterpart include decreased time needed for preparation and administration, reduction in intravenous line‐associated complications (including infections and thrombophlebitis), decreased cost of health professionals needed to administer the drug, and early discharge from a treatment facility 4 …”

“…Acknowledging the association between Corynebacterium species and granulomatous mastitis, this patient was initiated on a trial of doxycycline 100 mg orally twice daily and clindamycin 450 mg orally thrice daily to facilitate penetration of lipophilic antibacterials into breast tissue. Her case was also discussed with a breast surgeon, given the paucity of literature guiding the treatment of granulomatous mastitis 1 . She will be followed up routinely by both a breast surgeon and an infectious diseases consultant to assess for tolerance of therapy and clinical improvement.…”

Uncommon Location of Idiopathic Granulomatous Mastitis: A Case Report

“…Immunosuppressive agents such as Methotrexate and Azathioprine are the two most common medications in unresponsive cases or patients who have developed complications due to steroids. 19 A study found a combination therapy of methotrexate and steroids with better response in IGM patients than steroids alone. 20 Also, Methotrexate had a high effectiveness methotrexate in patients resistant to corticosteroids.…”