Idiopathic Granulomatous Mastitis During Pregnancy

Abstract

Aim: Idiopathic granulomatous mastitis is a rare chronic inflammatory pathology of uncertain etiology that usually affects women of reproductive age between 20 and 40 years of age and women who have a history of breastfeeding. Due to its clinical presentation, it can be easily confused with other breast pathologies, so the clinician should suspect it at the first visit. The aim of presenting this clinical case is to illustrate the difficulties in diagnosis that the clinician may encounter when faced with a similar case, as well as the management considerations that must be taken into account in the case of a pregnant patient.

Clinical case: a 41-year-old pregnant patient with 13 1/7 weeks of gestation, G4P3003, two previous cesarean sections, with a disease time of 2 weeks reporting pain and swelling in the left breast. The patient had received oral antibiotic treatment with dicloxacillin; however, the pain persisted. He had no other important background. Her vital signs at the examination were stable. Physical examination revealed erythematous skin, accompanied by signs of local inflammation (increased volume, flushing and warmth) in the left breast, in addition to palpating 2 masses located in the upper internal quadrant and upper external quadrant, which were painful to the touch. The rest of the physical examination showed nothing remarkable. A breast ultrasound was performed, which raised the suspicion of probable infectious mastitis complicated by abscesses. It was decided to initiate empirical antibiotic treatment with clindamycin 900 mg EV c/8h for 9 days, with no apparent improvement, then clindamycin 300 mg PO c/8h for 5 days and non-steroidal anti-inflammatory drugs, without improvement. The chest x-ray, as well as the PPD test, were negative. Serology for ANA, ENA, ANCA, rheumatoid factor, Anti-smith, anti-dsDNA was negative. Biopsy of the left breast revealed the presence of a neutrophil infiltrate, with evidence of destruction of the ductolobulillar unit, as well as the presence of multinucleated giant cells and microabscesses. The histopathological study of the lesion was negative for the Ziehl Neelsen stain. The final diagnosis was idiopathic granulomatous mastitis. In the case of a pregnant patient, it was decided to opt for conservative outpatient medical management based on the literature that supports a self-limited evolution of the clinical picture.