Farhana Siraj¹*, Nazia Mehfooz², Suhail Mantoo¹, Shadab Maqsood³, Maniza Kanth⁴ and Ajaz Koul⁵

¹Associate Professor, Department of Internal Medicine, Sheri Kashmir Institute of Medical Sciences, Jammu & Kashmir, India
²Assistant Professor, Department of Respiratory Medicine, Sheri Kashmir Institute of Medical Sciences, Jammu & Kashmir, India
³Assistant Professor Department of Radiodiagnosis and Imaging, Sheri Kashmir Institute of Medical Sciences, Jammu & Kashmir, India
⁴Senior Resident Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Jammu & Kashmir, India
⁵Professor, Department of Internal Medicine, Sheri Kashmir Institute of Medical Sciences, Jammu & Kashmir, India

*Corresponding Author: Farhana Siraj, Associate Professor, Department of Internal Medicine, Sheri Kashmir Institute of Medical Sciences, Jammu & Kashmir, India.

Received: February 04, 2025; Published: February 26, 2025

Abstract

Background: Sarcoidosis is an inflammatory disease characterized by forming granulomas in various organs. It affects the lungs, lymph nodes, skin, and eyes in most cases, but isolated breast involvement is rare, with only a limited number of cases reported in the medical literature. Patients with breast sarcoidosis may be asymptomatic or present with a palpable breast lump, which can mimic common breast conditions such as breast fibro adenoma, abscess or breast carcinoma. Thus, accurate diagnosis is crucial to avoid unnecessary antibiotic usage and surgical procedures.

Case Presentation: A 39-year-old nonlactating female with diabetes mellitus presented with pain and swelling in the right breast for 1 year to the breast clinic at our institute without fever, chills, rigors or discharge. The patient had taken multiple courses of antibiotics with no symptomatic relief this year. On referral to the Department of Internal Medicine at SKIMS, the patient had a history of erythema nodosum (EN). The results of the present general examination and left breast examination were normal however, the right breast examination revealed a solid mass measuring approximately 2× 2 cm in the upper outer quadrant with normal skin and no palpable axillary lymph nodes. Her baseline investigations were normal, including complete blood count and chemical and urine examinations. Ultrasonography of the right breast revealed diffusely scattered hypoechoic areas in the retroareolar region and outer quadrant with features of peridal mastitis and multiple duct dilatation with thick contents. Mammography revealed mild asymmetrical enlargement of the right breast with BIRADS 3 morphology. The patient was managed with incision drainage. Aspirated pus samples for microbiological testing (AFB staining, Gram staining and culture, CB-NAAT, MTB culture) were negative. Mantoux test urine for AFB smears, chest X-rays, IGRAs, and vasculitic profiles (ANA, P-ANCA, C-ANCA, and anti-CCP) were negative. However, angiotensin-converting enzyme (ACE) levels and 24-hour urinary calcium levels were elevated. Computed tomography of the chest and abdomen was normal. Histopathological findings from a true cut biopsy of the right breast lesion revealed noncaseating granulomas infiltrating the breast tissue with many foreign body giant cells. AFB and CBNAAT of the biopsy were negative. The patient was diagnosed with primary breast sarcoidosis and managed with oral prednisolone and azathioprine. On follow-up, the mass size decreased, and the pain substantially improved.

Conclusion: Considering that sarcoidosis in a patient who presents solely with breast pain and swelling is rare but clinically suspicious, a thorough evaluation can guide patients to reach a proper diagnosis, which can significantly improve the overall prognosis.

Keywords: Sarcoidosis; Erythema Nodosum; Angiotensin Converting Enzyme

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Citation

Citation: Farhana Siraj., et al. “Every Granulomatous Lesion is Not Classified as Tuberculosis. Isolated Sarcoidosis Breast with Comprehensive Review of Literature". Acta Scientific Clinical Case Reports 6.3 (2025): 50-55.

Copyright

Copyright: © 2025 Farhana Siraj., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.