A Case of Granulomatous Mastitis

Granulomatous mastitis is a rare chronic inflammatory condition of the breast tissue involving formation of inflammatory granulations around the lobules and ducts of the breast tissue, forming one or more breast lumps, congestion pain, abscesses and fistulae. Although rare, it has been observed in increasing numbers of women during their late 20s and early 30s.The diagnosis can be done by biopsy, as it can rule out malignancy, sarcoidosis and infections like tuberculosis and fungal infections.

There is no generally accepted standard treatment. Steroids surgical excision and antibiotics have done little to help, as it has a pattern of recurring in various areas of the breast. Some women have undergone mastectomy which can be emotionally and physically debilitating.

A lady aged 35 years, came to me with multiple painful lumps in her left breast. Let’s call her Monica. It all started when her first baby was about 8 months old. She had a heavy feeling in the left breast, and felt a lump. She thought it was due to irregular menstrual cycles and ignored it for some time. However, it grew in size and felt like a ball. She saw her gynaecologist and had a biopsy, mammography and USG. It turned out to be non-cancerous, and as the breast was warm to touch, it was thought to be an abscess. She was given antibiotics and pain killers which did not resolve the problem. She was then advised to undergo aspiration and a small incision was made. The wound was kept open for drainage, and again antibiotics were given. In ten days a newly formed ‘pus balloon’ appeared which was again aspirated.

The patient reported:

“The site of the puncture started oozing and a big hole was formed in a week’s time. Antibiotics were continued. I was referred to an infectious disease doctor, as I had 5 oozing wounds by then. I was on antibiotics for 2 months more, but nothing changed. I started seeing more lumps. Then a surgical biopsy was advised, which revealed, Severe Granulomatous mastitis. All the other tests for culture for bacteria, fungi, and Acid Fast Bacilli, were negative. As of today, I have pain, ranging from mild to moderate, and I take an anti-inflammatory tablet every night. I do find some pus drainage from the wounds. The wounds have partially healed with Calendula Ointment, and the lump is almost gone now, but the oozing from the openings remains.’

Monica has a number of other issues. She has allergy to pollen in the spring and fall and sneezes all day during those episodes, gets swollen and watering eyes along with itchy throat and ears. She also has polycystic ovarian syndrome, since her menarche, at the age of 14, and does not get periods unless she takes hormone pills. She has hyperlipidaemia, and must take medicines for the same.

She is a non-vegetarian food lover and chicken is her favourite. Her digestion is fine but she had severe hyperacidity all through the nine months of her pregnancy.

She has a repetitive dream that her teeth are falling out.

I said to her ‘Please describe yourself as a person’

She said, ‘I am a very hyper reactive and impulsive, hot tempered person. I get angry very easily. I am a positive thinker, but worry too much. I am emotional and things affect me easily, especially pertaining to family and friends. But I’m kind gentle and stubborn too. I respect people and expect the same, I love dance and music. I go on auto pilot mode when I hear music and I start dancing’.

“Any major incident in your life that strongly affected you?”, I asked.

‘Once I was mugged in Europe, and lost my passport and visa. Luckily I knew all the details and was allowed to travel back. I had decided to kill myself if I would have to stay back. This is one major incident in my past. But it made me stronger, and confident to fight against any situation in life.’

I noticed that her tone was harsh, rash and short tempered, though she was friendly and helpful.

So here we have:

Anger- Irascible Rashness

Dreams- teeth falling

Dance, desire for

Food Drinks- Chicken desires

Menses irregular.

Abscesses Left breast

Overall the picture is characteristically a pattern of the tubercular miasm. The tubercular miasm is restless, aggressive and optimistic, has a tendency to recurrent infections and abscesses, and has a rebellious inclination and there is another polarity of the tubercular miasm to be weak delicate and sickly.

The prominent features in her case that boldly stood out were rashness, harshness- and recurrent abscesses in the left breast. Abscesses in the left breast are found under just two remedies, Cistus Can and Arnica. Interestingly, Reference works highlights Arnica under Anger- Rashness- Harsh.

Though all the other symptoms were pointing to Nux Vom, Arnica stood out clearly. Considering the current pathology we find there is a non healing discharging wound, with unhealthy granulation tissue.

On 20/6/2014 my first prescription was Calcarea Sulph 200X. Calc Sulph relates to obstinate suppurations that refuse to heal. I noticed that all through the case taking, her tone was that of lamenting . ‘I gave up my career to look after the baby and home, and now no one realises what a big sacrifice I made.’ We have ‘Lamenting, wailing, appreciated because she is not’ with Calc Sulph very prominent

I followed this with Arnica 200 for a few weeks. The wound stopped oozing and began to heal with healthy granulation.

Her follow up 2 months later:

‘I can feel positive changes happening in by breast tissue. I do have pain off and on, but when I take the homeopathic dose it helps. Also I get pus sites, but they are small in size and after rupture, a very small amount of pus comes out. I have had no severe allergies like before, but do get itchy throat.

A month later she again had a lump 1 inch in diameter with pain, and Calcarea Sulph 200X one dose was repeated. This drained and healed up in a week.

22/12/15 No lumps ever since. All the breast tissue is normal.

Granulomatous mastitis is a debilitating condition which was refractory to all other treatment options. It resolved brilliantly with homoeopathic treatment. Her Spring and Fall allergies are not as bad anymore. She has none of the incessant sneezing and swollen eyes. Also, her menstrual cycles have settled to a 45 day cycle now, and she no longer requires hormone pills.