Microbiology and Biological Markers

Abstract

The disease process of idiopathic granulomatous mastitis (IGM) is believed to be triggered by initial ductal epithelial damage. The exact triggers or causative agents for IGM are as yet unknown, making it difficult to provide targeted therapy. Apart from the local granulomatous inflammatory response to epithelial damage that has been proposed, there is also the theory of an autoimmune pathophysiology, supported by the positive response that patients display when treated with steroids and other immunosuppressant agents. The role of bacterial agents is also often under discussion but not yet fully proven with Corynebacterium kroppenstedtii as the bacterial agent mostly identified as a causative agent in the majority of cases reported. Various biomarkers have been implicated in the pathways of IGM and proposed by the literature as measures for diagnosis, disease progression, differentiation from breast cancer, and potential targets for the management of the disease. This chapter aims to review the findings of the published literature including the microbiology and proposed biomarkers. Serum CRP, IL-6 levels, and NLR are suggested biomarkers for the measurement of disease severity and time to resolution in patients with IGM. TREM-1 and IL33 are triggers that have been implicated in the pathway of the disease process and present themselves as potential targets in the management of IGM. The majority of literature presented, however, is retrospective, as the disease is rare, making the elucidation of management modalities challenging. Indeed, further research is required and recent publications prove promising in the guidance of management to date.