Methotrexate in the Treatment of Idiopathic Granulomatous Mastitis

Even though idiopathic granulomatous mastitis (IGM) is a benign breast lesion of the mammary grand, it poses a problem of diagnosis as it is a rare entity. Because it resembles breast abscess or inflammatory carcinoma, patients undergo surgical excision leading to breast scarring and disfigurement. In this work, we carried a prospective study of cases of IGM managed over the past 7 years from 2009 to 2015. Among 4200 patients who were treated for breast swelling, 40 cases of IGM were diagnosed. We present the clinical data of our IGM patients and results of treatment with corticosteroids and methotrexate. The mean age of presentation was 33 years, and the median duration of steroid and methotrexate treatment was 3 and 6–9 months, respectively. The diagnosis of IGM was confirmed by core needle biopsy in all the patients. With this combination therapy, all the patients showed complete resolution of IGM and the recurrence was observed in only 2 patients. Our study demonstrates that a combination of corticosteroids (prednisolone) and methotrexate is an ideal choice of treatment for IGM rather than the surgical excision. The combination of low doses of corticosteroids with methotrexate could significantly prevent the side effects of high doses of corticosteroids.