Differential diagnosis, investigations and treatment
In continuation, our investigation by mammography for breast mass revealed bilateral moderately dense fibroglandular breast parenchyma in the right retro-areolar region was a poorly defined area of increased density. Ultrasound revealed an irregularly outlined hypoechoic mass measuring 19 mm x 17 mm x 20 mm. Ultrasound-guided core biopsy of the mass was performed. The biopsy demonstrated features of chronic granulomatous mastitis that was negative for malignant cells (Fig.1). Stains, in order to detect bacterial (Gram), fungal elements (PAS, Grocott’s), and acid-fast bacilli (Ziehl-Neelsen), were negative. In continuation, negative results were obtained for the brucellosis serologic and autoimmune disease tests. The patient was treated conservatively with steroids and showed good resolution of her symptoms within one month, but after 2months, the patient presented with symptoms of joint pain and headache. She was tested for brucellosis and other tests because she lived in a Brucella endemic area and used local dairy products. The Brucella agglutination tests showed positive results with tetration Wright: 1/160,2ME: 1/80, Coombs Wright: 1/160. Therefore, she was treated with doxycycline and rifampin for six weeks, and prednisolone was continued as prescribed. The symptoms and signs of the recent illness (Brucella) improved. Moreover, prednisolone was tapered out and stopped within five months of its initiation.