Corticosteroid and Azithromycin in Idiopathic Granulomatous Mastitis

Document Type : Original Article

Authors

1 Department of Infectious Diseases, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student Research Center, Dentistry School, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Oral and maxillofacial Pathology, Dentistry School, Khorasgan University, Isfahan, Iran

4 Dentistry School, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Mastitis is an inflammatory disorder in breast tissues due to bacterial factors, mycobacterial infections or autoimmune diseases. Idiopathic granulomatous mastitis (IGM) is a form of mastitis which may be affected by systematic diseases such as sarcoidosis, and infectious causes such as mycobacterium and fungus. This study evaluates the efficacy of medical therapy with a combination of corticosteroid and Azithromycin in patients with IGM. Materials and Methods: This study is a clinical trial research carried out in Alzahra Hospital (Isfahan, Iran) in 2013 on granulomatous mastitis patients. It was administered 250 mg of Azithromycin per 12 hour and 60 mg of Prednisolone per day within 2 weeks. Next, they took 40 mg/day within 8 weeks, and this dosage was tapered during 6 months and the patients clinically and radiologically followed up. The studied patients were examined within 1 week, 2 weeks, 1 month, 3 months, and 6 months, from the beginning of treatment. Results: This study investigated granulomatous mastitis patients in Alzahra hospital in 2013. The mean age of these patients was 33.6 ± 8.9, and their age range was 18–56 years old. Among 26 studied patients, 24 persons (92.3%) according to follow-up the patients by physical examination and sonography responded to treatment of corticosteroid and Azithromycin. The remaining (7.7%) underwent surgery. Treatment periods in case of drug use were respectively, 8.5 ± 0.71 months. Conclusion: Treatment with corticosteroid and Azithromycin is an effective and appropriate treatment for IGM.

Keywords

1.
Al-Jarrah A, Taranikanti V, Lakhtakia R, Al-Jabri A, Sawhney S. Idiopathic granulomatous mastitis: Diagnostic strategy and therapeutic implications in Omani patients. Sultan Qaboos Univ Med J 2013;13:241-7.  Back to cited text no. 1
    
2.
Franklin O, Lowly C. Norwegian mastitis control programme. Ir Vet J 2009;62 Suppl 4:S26-33.  Back to cited text no. 2
    
3.
Stary CM, Lee YS, Balfour J. Idiopathic granulomatous mastitis associated with Corynebacterium sp. infection. Hawaii Med J 2011;70:99-101.  Back to cited text no. 3
    
4.
Eric CH. Role of conservative treatment in idiopathic granulomatous mastitis. Breast J 2005;11:454-6.  Back to cited text no. 4
    
5.
Maffini F, Baldini F, Bassi F, Luini A, Viale G. Systemic therapy as a first choice treatment for idiopathic granulomatous mastitis. J Cutan Pathol 2009;36:689-91.  Back to cited text no. 5
    
6.
Erozgen F, Ersoy YE, Akaydin M, Memmi N, Celik AS, Celebi F, et al. Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat 2010;123:447-52.  Back to cited text no. 6
    
7.
Su FH, Liu SC, Suen JH, Chen DS, Lou SM. Idiopathic granulomatous mastitis: A case successfully treated with a minimum dose of a steroid. Chang Gung Med J 2005;28:431-5.  Back to cited text no. 7
    
8.
Hladik M, Schoeller T, Ensat F, Wechselberger G. Idiopathic granulomatous mastitis: Successful treatment by mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2011;64:1604-7.  Back to cited text no. 8
    
9.
Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N. Idiopathic granulomatous mastitis: A report of twenty cases. Diagn Interv Imaging 2012;93:586-96.  Back to cited text no. 9
    
10.
Kim J, Tymms KE, Buckingham JM. Methotrexate in the management of granulomatous mastitis. ANZ J Surg 2003;73:247-9.  Back to cited text no. 10
    
11.
Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic granulomatous mastitis: Time to avoid unnecessary mastectomies. Breast J 2004;10:318-22.  Back to cited text no. 11
    
12.
Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M. Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today 2011;41:333-7.  Back to cited text no. 12
    
13.
Lacambra M, Thai TA, Lam CC, Yu AM, Pham HT, Tran PV, et al. Granulomatous mastitis: The histological differentials. J Clin Pathol 2011;64:405-11.  Back to cited text no. 13
    
14.
Bellavia M, Damiano G, Palumbo VD, Spinelli G, Tomasello G, Marrazzo A, et al. Granulomatous mastitis during chronic antidepressant therapy: Is it possible a conservative therapeutic approach? J Breast Cancer 2012;15:371-2.  Back to cited text no. 14
    
15.
Taghizadeh R, Shelley OP, Chew BK, Weiler-Mithoff EM. Idiopathic granulomatous mastitis: Surgery, treatment, and reconstruction. Breast J 2007;13:509-13.  Back to cited text no. 15
    
16.
Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet 2011;284:1189-95.  Back to cited text no. 16
    
17.
DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisonemanagement of granulomatous mastitis. N Engl J Med 1980;303:799-800.  Back to cited text no. 17