Idiopathic granulomatous mastitis in the United Arab Emirates: a retrospective case series of clinical features, management, and outcomes.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory breast disease that mimics infection and malignancy, with no standardized treatment approach. METHODS: We conducted a single center retrospective case series of 25 women with histopathologically confirmed IGM managed at a tertiary center in Dubai, UAE (June 2022-June 2025). Demographic, clinical, imaging, histopathological, treatment, and outcome data were analyzed. Remission was defined as complete clinical and radiological resolution sustained for at least 6 months after cessation of therapy. The median follow-up duration was 20 months. RESULTS: The median age was 38 years; all patients were pre-or perimenopausal, and 92% (n = 23) had a history of breastfeeding. The most common presenting features were tenderness (92%, n = 23) and a palpable mass (88%, n = 22). Ultrasound frequently identified abscesses (60%, n = 15) and axillary lymphadenopathy (56%, n = 14), whereas mammography showed ductal dilatation (48%, n = 12) and solid masses (32%, n = 8). Histopathology demonstrated lobulocentric non-caseating granulomas in 72% (n = 18) and cystic neutrophilic granulomatous mastitis in 28% (n = 7) (n = 7), with overlapping abscess formation in 40% (n = 10). Medical therapy alone was used in 52% (n = 13) of patients and combined medical-surgical management in 48% (n = 12). Remission occurred in 69% (n = 9) of medically managed patients compared to 25% (n = 3) in the combined group. CONCLUSION: IGM predominantly affected young, parous women and showed a heterogeneous clinical course. Medical management with corticosteroids, with or without disease-modifying anti-rheumatic drugs, appears to be associated with higher observed remission rates than combined surgical approaches. Early diagnosis and timely immunosuppressive therapy may reduce recurrence and avoid unnecessary surgery. Limitations include the small sample size, retrospective single-center design, and heterogeneity of treatment regimens. Key Points • Idiopathic granulomatous mastitis predominantly affected young, parous, premenopausal women with recent breastfeeding history. • Medical management with corticosteroids, with or without DMARDs, demonstrated higher observed remission rates than combined surgical approaches. • Surgical intervention was associated with greater complication burden, increased flares, and more chronic disease. • Early diagnosis and timely immunosuppressive therapy may improve outcomes while reducing unnecessary surgery.