# A Case Report and Literature Review of Steroid-Resistant Granulomatous Mastitis: Dramatic Response to Methotrexate Following Failed Drainage and Corticosteroid Therapy

## TL;DR

A woman with a chronic breast condition unresponsive to surgery and steroids showed full recovery with methotrexate, suggesting it as a promising alternative treatment.

## Contribution

Demonstrates methotrexate's effectiveness in treating steroid-resistant granulomatous mastitis, offering a non-surgical alternative.

## Key findings

- The patient achieved complete clinical and radiologic resolution with methotrexate after failing surgical and corticosteroid treatments.
- Sustained remission was observed, highlighting methotrexate's potential in managing refractory granulomatous mastitis.
- Immunomodulatory treatment reduced the need for repeated surgeries and steroid use, lowering patient morbidity.

## Abstract

Idiopathic granulomatous mastitis is an uncommon benign inflammatory breast condition that often follows a prolonged and relapsing course and may closely resemble infection or malignancy, leading to repeated interventions. We describe a young multiparous woman with a long history of recurrent breast abscesses and persistent draining sinuses who failed multiple surgical drainages and prolonged systemic corticosteroid therapy. Ongoing disease activity prompted a shift in management to immunomodulatory treatment, after which the patient experienced gradual but complete clinical and radiologic resolution with sustained remission on follow-up. This case illustrates the potential role of methotrexate as an effective alternative in refractory disease and highlights the importance of considering steroid-sparing strategies to reduce morbidity and avoid unnecessary repeated surgical procedures.