Background Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. Difficulties can be experienced in the treatment of IGM due to the lack of a common consensus in the literature. Treatment options include corticosteroids, surgical treatment, immunosuppressive drugs and conservative treatment with antibiotics.
Objectives To present our experience about patients with IGM on immunosuppressive therapy.
Methods The data of patients with a diagnosis of IGM under immunosuppressive therapy followed in the rheumatology outpatient clinic of a tertiary center enrolled between September 2010 and August 2015 were evaluated retrospectively. 16 histopathologically diagnosed patients receiving immunosuppressive therapy were evaluated for their treatments and treatment responses.
Results The mean age of the patients, the average duration of immunosuppressive therapy and the average follow-up period were 35.9±6.5 years, 19.6±14.1 months and 28.3±17.8 months, respectively. Initially, 15 patients received (93.8%) steroids and methotrexate, and 1 patient (6.2%) was treated only with steroids. All patients responded well to initial therapy. Eight (53.3%) patients achieved remission with steroid + methotrexate. 2 of the other 7 patients relapsed after discontinuation of steroids and 1 after discontinuation of steroid + methotrexate. A positive response was obtained after the restart of treatment with steroids and methotrexate in these patients. Of these 7 patients, no recurrence was observed in 3 (42.9%) patients with only methotrexate and in 4 (57.1%) patients in the maintenance treatment with steroids and methotrexate. Lowered dose of steroid was associated with recurrence during follow-up of the patient taking only steroids as the initial treatment. 5 patients (33.3%) taking methotrexate had drug side effects, not necessitate stopping the treatment.
Conclusions Systemic immunosuppressive therapy is safe and effective in IGM. Azathioprine and methotrexate have been the most frequently used immunosuppressive drugs in the literature. Our experience with methotrexate-based regimen allows the rapid reduction of the steroid dose and leads to remission.
Konan A, Kalyoncu U, Dogan I, Kiliç YA, Karakoç D, Akdogan A, Kiraz S, Kaynaro Lu V, Onat D. Combined long-term steroid and immunosuppressive treatment regimen in granulomatous mastitis. Breast Care (Basel). 2012 Aug;7(4):297–301.
Sheybani F, Sarvghad M, Naderi HR, Gharib M. Treatment for and clinical characteristics of granulomatous mastitis.Obstet Gynecol. 2015 Apr;125(4):801–7.
Disclosure of Interest None declared