Granulomatous Mastitis: Manifestation of Primary Sarcoidosis Masquerading as Tubercular Mastitis

Author(s): Richmond Ronald Gomes

Sarcoidosis is a multisystem disease of unknown etiology that affects young to middle aged adults, characterized by granuloma formation in various tissues, most commonly the lungs, lymphatics, skin and eyes. Involvement of the breast in sarcoidosis is rare. The breast is involved in less than 1% of cases and can be defined into three subsets, including granulomas localized to the breast, referred to as breast sarcoidosis. Breast can be either a primary or a secondary site of presentation. Breast sarcoidosis often mimics carcinomas at clinical examination. It may present with systemic findings such as erythema nodosum, arthritis, and uveitis, and unlike typical sarcoidosis, commonly manifests during pregnancy. We report a case of breast Sarcoidosis in a 35-year-old lady presenting as recurrent breast abscess with polyarthralgia. On histology, it was characterized by non-caseating giant cell granulomas. Differential diagnoses included idiopathic granulomatous mastitis, tuberculosis, fungal infection, cat-scratch disease, and sarcoid-like reactions to cancer. She was started anti tubercular therapy but responded poorly. Further clinical and laboratory investigations were consistent with a diagnosis of sarcoidosis. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated. The patient received treatment with corticosteroid and immunosuppressive, methotrexate and is presently asymptomatic. Breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast.