Authors: Natalia Collazos Torres , Ximena Briceño Morales , Sandra Milena González Rodríguez , Sara Marcela Guerrero Vallecilla , Verónica López Góngora , Ángela María García Sañudo , Clara Briceño Morales

Abstract

Background: Idiopathic granulomatous mastitis is a benign, chronic inflammatory disease of the breast that predominantly affects women of reproductive age. It is characterized by non-caseating granulomas involving the mammary lobules. Clinical manifestations range from breast pain and induration, to cutaneous fistulas and breast deformity. In recurrent or extensive disease, management may require radical surgical approaches followed by reconstruction. We report the case of a patient who experienced a relapse after salvage surgery in the remote donor area (abdomen), raises questions about whether the initial diagnosis of idiopathic granulomatous mastitis was incorrect, and whether what the patient presented from the beginning corresponded to a skin or connective tissue manifestation secondary to her autoimmune disease.

Case Presentation: A 28-year-old female presented with a two-year history of multiple emergency department visits for recurrent mastitis, treated with various antibiotic regimens, with late diagnosis of systemic lupus erythematosus and idiopathic granulomatous mastitis who underwent bilateral mastectomy with Deep Inferior Epigastric Perforator flap reconstruction, and subsequently developed recurrence in the non-native tissue. 

Conclusion: This case highlights the aggressive clinical course that idiopathic granulomatous mastitis may exhibit and underscores its potential for recurrence, even after radical surgical management and reconstruction. Idiopathic granulomatous mastitis that presents as a severe, refractory, and recurrent disease, and does not follow the usual clinical course, may be exacerbated by another concurrent illness. Further research is needed to clarify not only the origin of this condition, but also the predictors of recurrence, and to propose effective therapeutic options.

Keywords: Granulomatous mastitis, mastectomy, systemic lupus, erythematosus, perforator flap, breast diseases, case report.