Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan.
Department of Diagnostic Pathology, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan.
Medicina (Kaunas). 2023 Aug 3;59(8):1418. doi: 10.3390/medicina59081418.
: Granulomatous mastitis is a benign disease with a clinical presentation similar to that of breast cancer, and is most commonly observed in women of childbearing age. Although it has been suggested that autoimmune diseases are involved in its pathogenesis, no specific treatments have been established. The occurrence of this disease during pregnancy has rarely been reported. We presented the case of a 37-year-old woman who complained of left breast induration at 24 weeks' gestation. : She was pregnant and manifested a dichorionic, diamniotic placenta. At 24 weeks of gestation, the patient experienced a sensation of hardness in her left breast. Mastitis was suspected, and she was treated with cephem antibiotics. Simultaneously, she was diagnosed with erythema nodosum in the extremities. As her symptoms did not improve, an incisional drainage was performed. Bacterial cultures were obtained at 31 weeks of gestation, and Corynebacterium kroppenstedtii was detected. : An elective cesarean section was performed at 37 weeks of gestation, and the baby was delivered safely. After delivery, a needle biopsy was performed, and the patient was diagnosed with granulomatous mastitis. She was completely cured with prednisolone after weaning. In this case, the patient's condition was maintained through incision and drainage, as well as antibiotic, anti-inflammatory, and analgesic drugs during pregnancy. This approach was chosen, taking into consideration the potential side effects of steroids. : This case suggests that incisional drainage and antibiotic therapy, as well as steroids and surgery, may be considered in the treatment of granulomatous mastitis occurring during pregnancy. This may also be true for management during delivery. After delivery, breastfeeding and steroidal therapy proved to be effective in treating the condition.
肉芽肿性乳腺炎是一种良性疾病，临床表现类似于乳腺癌，多见于育龄期妇女。虽然有人认为自身免疫性疾病与该病的发病机制有关，但尚未确立特定的治疗方法。妊娠期发生该病的情况很少见。我们报告了 1 例 37 岁女性患者，其在妊娠 24 周时出现左侧乳房硬结。
该患者为单绒毛膜双羊膜囊胎盘，妊娠 24 周时自觉左侧乳房发硬是其主要表现，考虑乳腺炎，予头孢菌素类抗生素治疗，同时患者四肢出现结节性红斑。患者症状无缓解，予切开引流术，于 31 周时行细菌培养，检出科氏棒状杆菌。
患者于妊娠 37 周行剖宫产术，母婴安全。产后行穿刺活检，诊断为肉芽肿性乳腺炎，患者于哺乳期结束后应用泼尼松治疗，病情完全缓解。本病例中，考虑到类固醇的潜在副作用，我们选择在妊娠期通过切开引流、使用抗生素、抗炎和镇痛药物来控制病情。对于分娩期间的管理，这种方法也可能适用。产后哺乳和类固醇治疗被证明对治疗该病有效。
本病例提示，对于妊娠期发生的肉芽肿性乳腺炎，可考虑切开引流和抗生素治疗，以及类固醇和手术治疗。分娩期间的管理也可能适用。产后哺乳和类固醇治疗被证明对治疗该病有效。
