Pos1358 clinical Presentation and Management of Idiopathic Granulomatous Mastitis in a Middle Eastern Population

Abstract

BackgroundIdiopathic Granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with poorly understood aetiology or risk factors. IGM has a predilection towards women of child-bearing age with a history of breastfeeding, particularly among Hispanic and Asian ethnicities. However, the true prevalence is unknown with IGM being poorly studied in Middle Eastern Arab and Levantine women who have different genetic, epidemiological, and environmental characteristics.ObjectivesTo study the clinical features of Middle Eastern women diagnosed with biopsy-confirmed IGM.MethodsA retrospective observational study of patients with a biopsy-confirmed diagnosis of IGM, referred to two different private outpatient rheumatology clinics in Amman- Jordan between 2016-2021. The Patients’ characteristics, clinical presentation, treatment, and outcomes were recordedResultsA total of 25 patients were identified in this study. The mean age was 34.9 ± 5.2 years. All females presented with a breast nodule and tenderness, while only 16% reported associated skin changes in the breast and 12% reported galactorrhoea. Bilateral breast involvement occurred in only 4 patients (16%) while 21 patients had unilateral breast involvement. Systematic manifestations including myalgia/arthralgia, skin changes, fever, and axillary lymphadenopathy were reported by 44%, 16%, 20%, and 16% of patients, respectively.Notably, all enrolled females were married at the time of presentation and 3 of them were pregnant or postpartum during the onset of symptoms. The majority of patients (n= 21, 84%) had a prolonged period of breastfeeding (> 6 months). Moreover, 80% of patients had ≥3 pregnancies with 60% having their youngest child aged 3-5 years.20 patients (80%) had a complete resolution of symptoms, and 20% (n=6) were lost to follow-up. Among patients who completed follow-up, treatment duration lasted for ≥ 1 year in 36% (n=9) of patients, whereas 11 patients had a complete resolution in less than a year. Azathioprine, methotrexate, antibiotics, and steroids were used in the treatment of 20%,36%, 60%, and 68%, respectively. Of note, only 1 patient underwent surgical intervention during treatment.ConclusionMany theories had suggested different aetiology for IGM but, in our cohort, it appears that being multiparous and prolonged breastfeeding carry higher risks of developing granulomatous mastitis. Although the aetiology is unclear, early diagnosis and the introduction of treatment using steroid therapy and immunosuppression can improve prognosis and prevent unnecessary surgery. Most of our patients that were treated with corticosteroid, Azathioprine, and Methotrexate had a complete resolution of symptoms after one year of therapy.Disclosure of InterestsNone declared