Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids
Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids
Background/aim: Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory disease of the breast. Erythema nodosum (EN) is a rare extramammary manifestation of IGM. The purpose of this study is to determine the clinical and demographic characteristics of 11 IGM and EN patients and to evaluate the efficacy of methylprednisolone treatment. Materials and methods: In our series, ten patients had EN bilaterally, whereas one patient had a lesion of the right pretibial area. The mean age of the patients was 35.5 years (range: 29 45 years). IGM and EN were diagnosed by the necessary serological, microbiological, radiological, and histopathological examination. After diagnosis, methylprednisolone was started in the first week at 0.8 mg/kg daily for treatment. The weekly dose was tapered to 0.1 mg/kg daily over 8 weeks. Results: We started with the treatment of methylprednisolone, and in all our cases the initial response was excellent. In 2 weeks the IGM symptoms had markedly declined, while signs of EN disappeared completely. Patients were followed for an average of 60 months after treatment. None of the 11 patients had recurrence. Conclusion: We herein report a rare series considering IGM cases complicated by EN. Few such cases have been reported in the literature. We advocate for an initial trial of methylprednisolone treatment, which proved to be very successful in our patients.
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- 1. Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH, Nam SJ. Granulomatous mastitis: mammographic and sonographic appearances. Am J Roentgenol 1999; 173: 317-320.
- 2. Imoto S, Kitaya T, Kodama T, Nam SJ. Idiopathic granulomatous mastitis: case report and review of the literature. Jpn J Clin Oncol 1997; 27: 274-277.
- 3. White WL, Hitchcock MG. Diagnosis: erythema nodosum or not? Semin Cutan Med Surg 1999; 18: 47-55.
- 4. Adams DH, Hubscher SG, Scot DG. Granulomatous mastitis a rare cause of erythema nodosum. Postgrad Med J 1987; 63: 581-582.
- 5. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 1972; 58: 642-646.
- 6. Ozturk E, Akin M, Can MF, Ozerhan I, Kurt B, Yagci G, Tufan T. Idiopathic granulomatous mastitis. Saudi Med J 2009; 30: 45-49.
- 7. Lee HJ, Oh KK, Kim EK, Kwack KS, Jung WH, Lee HK. Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei Med J 2006; 47: 78-84.
- 8. Al-Khaffaf BH, Shanks JH, Bundred N. Erythema nodosum an extramammary manifestation of granulomatous mastitis. Breast J 2006; 12: 569-570.
- 9. Alungal J, Abdulla MC, Narayan R. Idiopathic granulomatous mastitis with erythema nodosum and polyarthritis. Reumatismo 2016; 68: 97-99.
- 10. Nakamura T, Yoshioka K, Miyashita T, Ikeda K, Ogawa Y, Inoue T, Yamagami K. Granulomatous mastitis complicated by arthralgia and erythema nodosum successfully treated with prednisolone and methotrexate. Intern Med J 2012; 51: 2957- 2960.
- 11. DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. New Engl J Med 1980; 303: 799-800.