Granulomatous Mastitis

A 22-year-old woman with no history of pregnancy or comorbidities was admitted to the Infectious Diseases Clinic at Atatürk University Medical Faculty Hospital with a 2-month history of swelling, pain, and purulence in the left breast. Her readings were as follows: leukocyte count, 7300; neutrophil value, 63%; platelet count, 232,000; C-reactive protein, 3; sedimentation rate, 5; aspartate aminotransferase, 26; alanine aminotransferase 24, PPD, 25 mm; and Quantiferon was positive. The patient was diagnosed with pulmonary tuberculosis. Ultrasonography revealed a dense lesion in the lower left breast. Lymphadenopathy (18×7 mm) was observed in the left axillary region¹. Despite 2 weeks of antibiotic therapy, the magnetic resonance imaging (MRI) of the breast revealed a fistulized, thick-walled abscess formation on the skin, accompanied by skin thickening in the lower inner quadrant of the left breast (Figure 1). Biopsy results indicated granulomatous mastitis. Tuberculosis-related mastitis was suspected. Anti-tuberculosis quadruple therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) was administered for 2 months, while isoniazid and rifampicin were administered for 7 months^2,3. Post-treatment MRI showed no abscess or fistula tract formation (Figure 2). The 6-month follow-up revealed no new findings, demonstrating a complete response to tuberculosis mastitis treatment. It is important for tuberculosis to be considered in cases of mastitis, particularly when differentiating from widely seen idiopathic granulomatous mastitis.

FIGURE 1:
Axial T1 weighted MRI image: Pre-treatment image shows fistulized thick-walled abscess formation with thickening of the skin in the lower inner quadrant of the left breast (arrows).

FIGURE 2:
Axial T1 weighted MRI image: Post-treatment axial contrast-enhanced image shows no inflammation and/or abscess at the left breast.

ACKNOWLEDGMENTS

We offer our deepest thanks to the Atatürk University Faculty of Medicine that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Freeman CM, Xia BT, Wilson GC, Lewis JD, Khan S, Lee SJ, et al. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg. 2017;214(4):701-6. Available from: https://doi.org/10.1016/j.amjsurg.2017.07.002
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• ²
  Farouk O, Abdelkhalek M, Abdallah A, Shata A, Senbel A, Attia E, et al. Rifampicin for Idiopathic Granulomatous Lobular Mastitis: A Promising Alternative for Treatment. World J Surg. 2017;41:1313-21. Available from: https://doi.org/10.1007/s00268-016-3857-7
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  Thimmappa D, Mallikarjuna MN, Vijayakumar A. Breast Tuberculosis. Indian J Surg. 2015;77(Suppl 3):1378-84. Available from: https://doi.org/10.1007/s12262-015-1272-1
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• Financial Support: No financial support was used in this study.

Publication Dates

• Publication in this collection
  12 Nov 2021
• Date of issue
  2021

History

• Received
  06 Aug 2021
• Accepted
  08 Sept 2021