Idiopathic granulomatous mastitis: a mimicking disease in a pregnant woman: a case report

Abstract

Background: Idiopathic granulomatous mastitis is a rare, benign, inflammatory chronic condition of unclear etiology.This case is reported because it illustrates how idiopathic granulomatous mastitis can mimic other diseases, making it difficult to associate the presenting symptoms and the correct diagnosis; This disease is a challenge for clinicians to diagnose, manage and avoid iatrogenic complications, and requires consultation with experts in several specialties.

Case presentation: The patient was 30 years old, South-American, eleven weeks pregnant, and with an apparent infectious mastitis. She presented with progressive worsening of her breast symptoms and multiple negative laboratory tests. She suffered different side effects from several prescribed treatments and endured a prolonged recovery. The article emphasizes the need for ruling out common pathologies to arrive at the correct diagnosis such as bacterial and fungal infections; granulomatous conditions like tuberculosis and sarcoidosis; and inflammatory breast carcinoma. It also describes frequently used pharmacological and supplementary forms of treatment for patients with this condition.

Conclusion: Idiopathic granulomatous mastitis is a rare unusual condition of unknown etiology. Pathological confirmation is required for its diagnosis and optimal management is still unclear. The presentation and management of this case is intended to advance its awareness to physicians from different specialties.

Figures

Figure 1

A photograph of the patient’s left breast. Clinical appearance of the patient’s breast including skin ulcerations, abscesses and fistulae. Photo obtained at the end of her first hospital admission.

Figure 2

Histology slide 1 of the patient’s left breast specimen. Granulomatous inflammation with microabscess is observed, showing a granuloma with two giant cells and central inflammation. This sample was obtained by true-cut biopsy during her first hospital admission.

Figure 3

Histology slide 2 of the patient’s left breast specimen. Acute mastitis with polymorphonuclear cells within a terminal duct lobular unit.