Diagnostic and Therapeutic Challenges in Idiopathic Granulomatous Mastitis

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Idiopathic granulomatous mastitis (IGM) is an uncommon, benign inflammatory disorder of the breast that often presents with features suspicious for malignancy, creating substantial diagnostic and therapeutic challenges. Predominantly affecting parous women of childbearing age, the disease is characterized by a chronic inflammatory course with recurrent abscess formation and significant patient morbidity. Despite increasing recognition, the pathogenesis of IGM remains poorly understood, and consensus regarding optimal management is lacking. While histologic identification of non-caseating granulomas supports the diagnosis, biopsies may be nondiagnostic. Thus, heightened clinical awareness is essential. This report describes a challenging case of refractory IGM that underscores the need for early recognition and thoughtful, patient-centered management.

A 38-year-old woman with a history of methylenetetrahydrofolate reductase mutation and prior miscarriage presented with recurrent right breast abscesses and episodic axillary lymphadenopathy. Cultures intermittently grew Corynebacterium and Acinetobacter species, while multiple specimens demonstrated no growth. Core needle biopsy revealed stromal fibrosis with focal usual ductal hyperplasia but no granulomatous inflammation. Despite nondiagnostic pathology, the patient's imaging findings and protracted clinical course raised strong suspicion for IGM. Given the unclear etiology of her persistent symptoms, she underwent comprehensive multidisciplinary assessment. Breast surgical evaluation guided biopsy strategy and procedural management; infectious disease provided input on antimicrobial therapy; rheumatology assisted in evaluating systemic inflammatory or autoimmune contributors; and endocrinology assessed for hormonal or metabolic factors that might influence disease activity.

IGM remains a challenging clinical entity requiring a high index of suspicion to avoid misdiagnosis and unnecessary surgical intervention. Increasing recognition of inflammatory breast diseases has shifted treatment paradigms toward individualized, multidisciplinary care rather than reflexive operative management. This case underscores the importance of early specialist involvement, thoughtful therapeutic selection, and patient-centered decision-making in achieving durable disease control while minimizing morbidity.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1986

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