Cabergoline and Low-Dose Steroid Therapy İn Idiopathic Granulomatous Mastitis

Abstract

Introduction: Idiopathic granulomatous mastitis(IGM) is a rare, chronic granulomatous inflammatory disease of the breast. It is mostly seen in young women with a history of breastfeeding. It typically presents as a painful lump in the breast, erythema, focal abscess formation, skin ulceration, or fistula. The etiology and pathogenesis of IGM could not yet be well understood. It is thought to be caused by a localized autoimmune response against fat and protein-rich secretions leaking from the lobules due to previous hyperprolactinemia. There is no definite treatment protocol defined for IGM. Pharmacological agents and surgical interventions are used alone or in combination in the treatment. In this study, we aimed to examine the results of patients who were treated with cabergoline and low-dose steroids for IGM in our center. Methods: In this study, the files of patients who were treated with cabergoline and steroids for idiopathic granulomatous mastitis in our clinic were reviewed retrospectively. 36 patients were included in the study. The patients were invited to the outpatient clinic for the final examination. Demographic characteristics of the patients, symptoms at presentation, examination findings, laboratory tests, radiological imaging, tru-cut biopsy results, microbiological culture results, treatment doses and durations, remission times, surgery requirements, and recurrence were recorded. Results: All 36 patients included in the study were women of childbearing age. The most common presenting complaint was a palpable painful mass. Abscesses were present in 12 patients. Ulcers were observed in 9 patients and fistulas were observed in 4 patients. The most common involvement was in the lower outer quadrant. S.aureus was detected in the culture of 1 patient. Complete recovery was observed in 20 of 36 patients as a result of the treatment. The mean duration of remission was 2.85±2.54 months. The treatment of 29 (74.3%) patients was completed medically. Surgical excision was performed in 7 patients with a residual lump. No recurrence was observed during the follow-up period of 27.88 ± 8.21 months. Conclusion: The treatment of IGM is still controversial. The fact that cabergoline and low-dose steroid therapy provides remission in a short time, minimizes the need for surgery, and does not relapse in medium-term follow-up shows that it is a successful option in IGM treatment.