SAT0599 Idiopathic granulomatous mastitis may response well to combination of immunosupresives and glucocorticoids

Abstract

Background Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of breast. Corticosteroids (CS) and immunosuppressive agents constitute treatment alternatives other than surgery. Objectives To evaluate the clinical characteristics and treatment responses of IGM patients followed up in our clinic. Methods The medical records of 70 IGM patients who were referred to Hacettepe University Rheumatology Clinic were examined. Forty-four patients who had at least one visit in the last 2 years were included in the analysis. Demographic, clinical and laboratory characteristics of the patients, treatments, clinical and/or ultrasonographically measured lesion sizes at the time of diagnosis and at the last follow-up were recorded. Complete and partial response in the last control visit were defined as ≥50% and<50% decrease in the lesion size, respectively. Lesions which are stable or increasing in size was accepted as unresponsive. Increase in the drug dose by the clinician or increasing of the lesion size during follow-up were considered as relapse. Results Median age was 35.7 (24.3–57.2) years and median symptom duration was 2.5 (0.2–54.1) months at baseline. Palpable mass (90.9%) and breast pain (88.1%) were the most common symptoms. Skin fistules and axillary lymphadenopathy were present in 16 (37.2%) and 15 (34.1%) patients, respectively. Erythema nodosum was seen in 5 (11.4%) patients during follow-up. The median follow-up duration was 10.5 (1.05–99.6) months. CS monotherapy and combination of CS and immunosuppressive were used in 3 (7.8%) and 38 (86.4%) patients, respectively. Three patients were followed up without treatment. The first immunosuppressive agent was methotrexate (MTX) in 32 patients (84.2%) and azathiopurine (AZA) in 6 patients (15.7%). In one patient, MTX was switched to AZA due to hepatotoxicity. Treatment regimens and responses of the patients are summarised in table 1. IGM lesions disappeared in 24 patients at the end of follow-up. In two patients who were on MTX and KS, surgical excision was required because of unresponsiveness. Among relapsed patients (n=5), 2 patients were on MTX and KS, 1 patients was on AZA and KS and 2 patients were on KS at the time of relapse. In one patient, relapse was observed 1 year after cessation of MTX and KS.Abstract SAT0599 – Table 1 First line treatments and responses at last follow-up visit* Conclusions In a case series previously published by our study group, the efficacy of the combined use of KS and immunosuppressant’s in IGM treatment was retrospectively studied.1 In this study, the efficacy of immunosuppressive therapy has been demonstrated with prospective approach. Reference [1] Konan A, et al. Breast Care2012;7:297–301. Disclosure of Interest None declared