Granulomatous Mastitis Occurring during Pregnancy: A Case Report

Abstract

Background and Objectives: Granulomatous mastitis is a benign disease with a clinical presentation similar to that of breast cancer, and is most commonly observed in women of childbearing age. Although it has been suggested that autoimmune diseases are involved in its pathogenesis, no specific treatments have been established. The occurrence of this disease during pregnancy has rarely been reported. We presented the case of a 37-year-old woman who complained of left breast induration at 24 weeks’ gestation. Materials and Methods: She was pregnant and manifested a dichorionic, diamniotic placenta. At 24 weeks of gestation, the patient experienced a sensation of hardness in her left breast. Mastitis was suspected, and she was treated with cephem antibiotics. Simultaneously, she was diagnosed with erythema nodosum in the extremities. As her symptoms did not improve, an incisional drainage was performed. Bacterial cultures were obtained at 31 weeks of gestation, and Corynebacterium kroppenstedtii was detected. Results: An elective cesarean section was performed at 37 weeks of gestation, and the baby was delivered safely. After delivery, a needle biopsy was performed, and the patient was diagnosed with granulomatous mastitis. She was completely cured with prednisolone after weaning. In this case, the patient’s condition was maintained through incision and drainage, as well as antibiotic, anti-inflammatory, and analgesic drugs during pregnancy. This approach was chosen, taking into consideration the potential side effects of steroids. Conclusions: This case suggests that incisional drainage and antibiotic therapy, as well as steroids and surgery, may be considered in the treatment of granulomatous mastitis occurring during pregnancy. This may also be true for management during delivery. After delivery, breastfeeding and steroidal therapy proved to be effective in treating the condition.

Idiopathic granulomatous mastitis: A challenging case report and comprehensive review of the literature

“…ery- thema a + Illdefined hypoechoic mass-like area LB 10:00 position 4 cm from the nipple +: Tuberculosis autoimmune disease,serology: negative + GM Oral steroids Injection triamcinolone mixed with lidocaine into the affected areas − a Gupta et Al [ 20 ] 2020 35 G1P1 a − − − + Lump in RB 2 2 months RB: Erythem. Lump4 × 4 cm LB: Swelling and Erythem − − RB: ill-defined heterogeneous echoes in the subareolar region LB: Abscess Upper outer quadrant of the RB +: Cultures: negative PCR test for TB: negative −: breast mass excised under local anesthesia Non-caseating granulomas and the absence of acid-fast bacilli LB: Draining the abscess Oral steroids + 8 Yoshino et Al [ 21 ] 2023 37 G4P2 Infertility treatment − − − a Sensation of hardness in LB 1 1 week LB: Erythema Induration a + Pyogenic mastitis a white blood cell 14,360/μL CRP 14.75 mg/dL Culture: C. kroppenstedtii + Granulomatous mastitis During pregnancy: ATB Draining the abscess After delivery: oral steroids + 18 Almobarak et Al [ 22 ] 2021 34 G2P2 − − − − + ...…”

Idiopathic Granulomatous Mastitis, Erythema Nodosum, and Polyarthritis

“…Only 2 previous cases’ manifestations resolved spontaneously 26 similar to our case, and only 1 case where IGM, polyarthritis, and EN coexist in the setting of a Corynebacterium infection. 25 …”