CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2022 January-February;181(1-2):90-4

DOI: 10.23736/S0393-3660.20.04304-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Idiopathic granulomatous mastitis associated with paliperidone

Mariana C. MARQUES ¹ ✉, Margarida COITEIRO ¹, Helena GASPAR ¹, Gabriela GASPARINHO ², José S. PEREIRA ¹

¹ Department of Gynaecology, Hospital Fernando Fonseca, Lisboa, Portugal; ² Department of Pathology, Hospital Fernando Fonseca, Amadora, Portugal

Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease. Physical and radiological findings mimic breast cancer making histopathological examination essential to a definitive diagnosis. Many factors have been associated with this condition: prior oral contraceptive use, history of pregnancy, breastfeeding, autoimmunity, antipsychotic medications and Corynebacterium infections. However, IGM pathogenesis remains unknown. We report a unique case of IGM associated with paliperidone treatment for schizophrenia. A 41-year-old female on palideridone for 18 months presented with a breast mass with extensive skin ulceration and fistulae. After exclusion of neoplastic, infectious and autoimmune etiologies, iatrogenic cause was considered and paliperidone discontinued. Healing of the ulcerated lesions and reduction of the fistulae caliber in the breast ultrasound (US) was verified four weeks after discontinuing the antipsychotic medication. IGM is clinically challenging because it mimics the two ends of breast diseases such as breast abscess and breast cancer. Antipsychotic therapy has been associated with IGM, mainly due to risperidone-induced hyperprolactinemia. Our case is an unusual presentation of the disease and to the best of our knowledge, the first case report of paliperidone induced hyperprolactinemia associated with IGM.

KEY WORDS: Breast neoplasms; Hyperprolactinemia; Mastitis; Paliperidone palmitate