Mourot Aurélie, Chalut Marianne, Grandjean-Lapierre Simon, Younan Rami, Bourré-Tessier Josiane
Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Université de Montréal, Montreal, Canada.
Department of Microbiology, Immunology and Infectious Diseases, Université de Montréal, Montreal, Canada.
Rheumatol Int. 2025 Jan 7;45(1):20. doi: 10.1007/s00296-024-05773-4.
Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast. Various clinical management approaches have been described, but their efficacy and optimal sequential order remain uncertain. We describe the first Canadian cohort of patients with IGM, discuss treatment outcomes and outline a practical management approach. This retrospective study included patients diagnosed with biopsy-confirmed IGM between 2014 and 2023, aged over 18 years. Based on a scoping review of the literature, a diagnostic and management approach was developed, and we present here the disease course and outcomes using this approach. 22 females were included, with a mean age of 40 (24-65) years, mostly presenting with a breast lump (n =22, 100%) and breast pain (n = 15, 68%). Mean rheumatology follow-up was 28.7 months (range 3-79). Mean time from first symptom to diagnosis was 3.5 months (range 1-13). Corynebacterium kroppenstedtii was found in 8 patients. Treatment including lipophilic antibiotics, corticosteroids and disease modifying anti-rheumatic drugs (DMARDs), led to complete remission in 95% of patients, in a mean time of 11.6 months (range 1-36), and relapse in only 1 patient. 11 patients required DMARDs (50%), most commonly methotrexate (n=9). We highlight the variable severity of IGM and the benefits of a severity-based treatment approach. A diligent evaluation and work-up is essential to manage IGM. The proposed severity-based management approach with medical treatment and less aggressive surgical intervention led to complete remission in 95%.
特发性肉芽肿性乳腺炎（IGM）是一种罕见的乳腺炎症性疾病。已有多种临床管理方法被描述，但它们的疗效和最佳顺序仍不确定。我们描述了加拿大首个IGM患者队列，讨论了治疗结果并概述了一种实用的管理方法。这项回顾性研究纳入了2014年至2023年间经活检确诊为IGM且年龄超过18岁的患者。基于对文献的范围综述，制定了一种诊断和管理方法，我们在此展示使用该方法的疾病进程和结果。纳入了22名女性，平均年龄为40（24 - 65）岁，大多数表现为乳腺肿块（n = 22，100%）和乳房疼痛（n = 15，68%）。风湿科的平均随访时间为28.7个月（范围3 - 79个月）。从首次症状出现到诊断的平均时间为3.5个月（范围1 - 13个月）。8名患者中发现了克氏棒状杆菌。治疗包括亲脂性抗生素、皮质类固醇和改善病情抗风湿药（DMARDs），95%的患者实现了完全缓解，平均时间为11.6个月（范围1 - 36个月），仅1例患者复发。11名患者需要使用DMARDs（50%），最常用的是甲氨蝶呤（n = 9）。我们强调了IGM严重程度的差异以及基于严重程度的治疗方法的益处。对IGM进行管理时，细致的评估和检查至关重要。所提出的基于严重程度的管理方法，采用药物治疗和较保守的手术干预，使95%的患者实现了完全缓解。
