Conference Coverage

Think methotrexate for granulomatous mastitis



– Methotrexate is the most effective therapy for granulomatous mastitis, according to Anna Postolova, MD, a rheumatology fellow at Stanford (Calif.) University.

Granulomatous mastitis is a rare inflammatory disease of the breast of uncertain but possibly autoimmune etiology. The most common treatments – antibiotics, prednisone, and incision and drainage – are often ineffective and have a roughly 50% recurrence rate. That’s why Stanford rheumatologists began using methotrexate more than a decade ago with impressive results, she explained at the 2018 Rheumatology Winter Clinical Symposium.

mood shot for RWCS & GUILD conferenes Bruce Jancin/MDedge News
Presenting symptoms of granulomatous mastitis include unilateral or bilateral pain, palpable mass, redness, swelling, skin induration, erythema, abscess and/or fistula formation, and discharge. The differential diagnosis involves periductal mastitis, breast cancer, infection, sarcoidosis, and granulomatosis with polyangiitis. Diagnosis of granulomatous mastitis requires histologic examination of a biopsy specimen.

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