Discussion
IGM is a chronic benign breast disease observed in women of childbearing
age, occurring within five years of the last delivery (2). Veyssiere et
al. 1967 described IGM for the first time (Veyssiere 1967, as cited in
Oze,2022) (2). The literature described that the prevalence of IGM is
associated with race and region (8). Its etiopathogenesis remains
unsolved, that diagnostic and therapeutic are challenging.
Non-mass-like lesions with restricted diffusion were observed in IGM.
Despite, these lesions being pathology, they may show clustered
ring-like enhancement same as malignant lesions (9). They are of
variable size, usually firm, tender, ill-defined, and unilateral (5). In
our patient, lesion was retroaleolar unilateral, ill-defined, tender and
warm in touch, and erythemato in appearance.
Often IGM is challenging to differentiate clinically and radiologically
from infectious etiologies such as tuberculosis and fungal infections,
and also from malignancy, thus posing a diagnostic dilemma (10). Our
patient had received a course of antibiotic treatment due to a make a
mistaken diagnosis of the infection. Also, she denied any previous
disease and recent breast trauma. Finally, checking the breast for
cancer and negative results for infectious tests led to the IGM
diagnosis.
There is no consensus about the optimal treatment for IGM (11). Several
treatment modalities exist for patients with IGM that, to resolve its
lesions completely, require more than one (12). A meta-analysis
illustrated that combining steroids and surgery in treating patients
with IGM is better than only steroids. It even may lead to a lower rate
of recurrence and side effects in these patients (13). In the last
years, surgery has been avoided in most cases, introducing a more
conservative medical approach(14). While some studies declare surgical
in IGM patients with wide excision provides the best long-term outcome
(15, 16).
In our case, the medical team did not recommend surgery, and
corticosteroids were used to treat IGM. Unfortunately, after taking
prednisolone for 2 months, she got Brucella disease. There is systemic
immune dysregulation in patients with IGM, so alterations in T cells,
NK, and NKT cells were reported (17). Moreover, prednisolone
can weaken the immune system and make it easier to get infections. The
literature demonstrates that corticosteroids increase the risk of severe
conditions and some opportunistic infections (18).
IGM is a challenging chronic inflammatory disease of the breast with
unknown etiology and unusual manifestations. Although the most
appropriate treatment protocol has not yet been identified, prednisolone
was used in our patient as an effective and practical choice in the
treatment of IGM.
Author Contributions
Shiva Shabani: Conceptualization; diagnosis and treatment of the case;
writing – original draft.
Bahman Sadeghi: Literature review; writing – original draft.
Nader Zarinfar: Contributing to the diagnosis and treatment of the case.
Roham Sarmadian: Contributing to the diagnosis and treatment of the
case.
All authors read and approved the final manuscript.