Differential diagnosis, investigations and treatment
In continuation, our investigation by mammography for breast mass
revealed bilateral moderately dense fibroglandular breast parenchyma in
the right retro-areolar region was a poorly defined area of increased
density. Ultrasound revealed an irregularly outlined hypoechoic mass
measuring 19 mm x 17 mm x 20 mm. Ultrasound-guided core biopsy of the
mass was performed. The biopsy demonstrated features of chronic
granulomatous mastitis that was negative for malignant cells (Fig.1).
Stains, in order to detect bacterial (Gram), fungal elements (PAS,
Grocott’s), and acid-fast bacilli (Ziehl-Neelsen), were negative. In
continuation, negative results were obtained for the brucellosis
serologic and autoimmune disease tests. The patient was treated
conservatively with steroids and showed good resolution of her symptoms
within one month, but after 2months, the patient presented with symptoms
of joint pain and headache. She was tested for brucellosis and other
tests because she lived in a Brucella endemic area and used local dairy
products. The Brucella agglutination tests showed positive results with
tetration Wright: 1/160,2ME: 1/80, Coombs Wright: 1/160. Therefore, she
was treated with doxycycline and rifampin for six weeks, and
prednisolone was continued as prescribed. The symptoms and signs of the
recent illness (Brucella) improved. Moreover, prednisolone was tapered
out and stopped within five months of its initiation.