A 34-year-old G3P2 Hispanic female, 28 weeks pregnant, presented with a 19cm right breast mass. She had a known
prolactinoma treated with
bromocriptine which was discontinued during her pregnancy. Ultrasound guided core biopsy procedure revealed
granulomatous mastitis. The patient was told that the mass would resolve with observation. The patient seen at another institution by an
infectious disease specialist who started treatment with
amphotericin for presumptive disseminated
coccidioidomycosis. Repeated titers were negative for coccidioides antibody. Repeat cultures were negative as well. Due to the persistence of the
infectious disease specialist, tissue cultures were performed on fresh tissue specimens, which did not grow bacterial, fungal, nor
acid fast organisms. The
amphotericin regimen resulted in no improvement of her breast mass after 10 weeks. Within two weeks of stopping the antifungal
therapy, however, the mass diminished to 6cm. The patient delivered at 39 weeks.
Bromocriptine was restarted, and within 4 weeks, the lesion was no longer palpable. She had not shown signs of recurrence for 32 months.
DISCUSSION: Treatment recommendations for
IGM vary widely but
antibiotics and antifungal medications are not recommended.
Corticosteroid treatment is most commonly recommended, however, outcomes may not be different from management with observation.
Prolactin may be involved in the pathophysiology of the process.
CONCLUSION: