Introduction
Idiopathic granulomatous mastitis (IGM) or granulomatous lobular
mastitis is a rare chronic inflammatory disease of the breast in women
(1). This disease commonly occurs shortly after a women’s last pregnancy
with a history of childbirth and breastfeeding that increases,
especially in developing countries (2, 3). Despite the reports of this
disease, which show an increase in its prevalence in recent years, the
cause of its etiopathogenesis remains little known and diversified (3).
An autoimmune or hypersensitivity reaction is the most common hypothesis
regarding the etiology of the disease. However, trauma to the epithelium
of the mammary ducts and extravasation of milk or duct secretions to the
connective tissue, hyperprolactinemia, oral contraceptives, or bacterial
origin have been considered (3, 4).
IGM usually presents with a unilateral or bilateral progressive painful
breast lump. Patients with chronic IGM can develop fistulae, sterile
abscesses, and nipple inversion (5). Bilateral IGMs have a higher
relapse rate and more excellent resistance to medical therapies than
unilateral IGMs (6). Histological evaluation applies to definite
diagnosis while imaging methods differential diagnosis for breast cancer
(3) because abscesses can lead to being mistaken for breast cancer (7).
Therefore, after causes must be considered, including breast cancer,
autoimmune breast disease, and infection, the final diagnosis of IGM is
often made (4, 7).
Although the most appropriate treatment protocol has not yet been
identified, some studies recommend surgical removal, while others
suggest medical treatment such as antibiotics, corticosteroids,
immunosuppressants, and anti-inflammatory drugs (3). The results of our
literature review about information and case report IGM are summarized
and exhibited in Table 1.
This study describes a patient who presented with a breast lesion
diagnosed as IGM, and two months after treatment with prednisolone, she
was infected by Brucella.