Idiopathic granulomatous mastitis diagnosed during pregnancy associated with successful breastfeeding experience

Abstract

Idiopathic granulomatous mastitis (IGM) is a rare benign breast condition with a course that is often rapidly progressive and slow to resolve. There is no consensus on management, especially during pregnancy and lactation. A 30-year-old at 33 weeks presented with mastalgia, induration and galactorrhoea in the left breast. There was no improvement with antibiotics. Initial workup was negative, and a core needle biopsy showed findings consistent with the diagnosis of IGM. She was treated with steroids antepartum. She was co-managed by rheumatology and her obstetrician/breastfeeding medicine specialist postpartum. She was treated with azathioprine, breastfed exclusively for 6 months and continued breastfeeding through the first year. A multidisciplinary team approach is crucial in diagnosing, treating, and facilitating successful breastfeeding in patients with IGM.

Spontaneous, idiopathic granulomatous mastitis in a pregnant patient: A case report and review of the literature

“…In addition, due to lack of familiarity, management plans may be suboptimal [ 21 ]. Treatments including expectant management, antibiotics, corticosteroids (or other anti-inflammatories), and surgical excision have all been cited [ 3 , 4 , 7 , 21 , 22 ]. As infectious agents must be excluded as a component of IGM diagnosis, it follows that antibiotic treatment is ineffective beyond prophylaxis during invasive diagnostic procedures.…”

“…With respect to steroid treatment, glucocorticoids, particularly prednisone, are used most often. Documented doses of oral corticosteroids range from 10 to 60mg/day [ 3 , [25] , [26] , [27] , [28] ]. While the treatment period can be lengthy [a median of 159 days has been reported [ 29 ]], oral steroid therapy is demonstrated to be effective.…”

“…Treatment will depend on symptoms, disease extent, and patient factors [ 38 ]. Supportive care is a key management consideration as the patient is required to cope with the long-term nature of the illness [ 3 ].…”

“…The primary presentation of IGM is a firm breast mass associated with intense local pain and subsequent skin ulcerations and fistulae [ 3 , 4 ]. It often progresses rapidly and is slow to resolve [ 3 ].…”

“…The primary presentation of IGM is a firm breast mass associated with intense local pain and subsequent skin ulcerations and fistulae [ 3 , 4 ]. It often progresses rapidly and is slow to resolve [ 3 ]. First documented in 1972 as a condition mimicking carcinoma [ 5 ], IGM presents a diagnostic dilemma as it imitates several other breast pathologies (lactational/infectious mastitis, abscess, and malignancy).…”