Treatment for and clinical characteristics of granulomatous mastitis

There are no randomized controlled trials demonstrating efficacy of any treatment modalities (glucocorticoids, antibiotics, or surgical interventions) in treatment of idiopathic granulomatous mastitis.1 Sheybani et al2 report their experience with oral corticosteroids and methotrexate. They should be congratulated on comprehensive reporting of their treatment outcomes. Although they achieved very excellent treatment outcomes, there are many important points that should be clarified. The authors report a low recurrence rate of three (13.6%) patients after steroid cessation. In our clinic, we treated nine patients with idiopathic granulomatous mastitis (age range 21–39 years) with initial steroid therapy (1 mg/kg for 3 weeks and tapered in 2 months). All patients had recurrence after steroid tapering within 3 months, except one patient who got pregnant and recovered spontaneously. The tuberculin skin test is not a reliable marker to make a differential diagnosis between idiopathic granulomatous mastitis and tuberculosis mastitis in moderate or high tuberculosis endemic countries.