Fatih ALBAYRAK, Orhan ZENGİN, Reha BARAN, Pınar KORKMAZ, Hüseyin ÇOLAK, Erdem TAŞ
Rheumatology Quarterly - 2026;4(2):128-132
Granulomatous mastitis (GM) is an inflammatory breast disease that may rarely be accompanied by systemic manifestations such as erythema nodosum (EN) and arthritis. In recent years, the association of GM with EN, with or without arthritis, has been recognized as GMENA syndrome. This report presents a case of GMENA syndrome and reviews the published literature. A 26-year-old woman presented with swelling, erythema, pain, and discharge in the left breast. Initial evaluation suggested infectious mastitis, but prolonged antibiotic therapy was ineffective. During follow-up, bilateral ankle arthritis and pretibial EN developed. Laboratory tests showed marked systemic inflammation. Core needle biopsy demonstrated chronic granulomatous inflammation, and microbiological studies were negative. The GMENA syndrome was diagnosed after exclusion of alternative causes. Methylprednisolone led to rapid improvement in both breast and systemic manifestations. A review of published cases showed a similar pattern of unilateral breast involvement, EN, and frequent peripheral arthritis or arthralgia, with generally favorable responses to corticosteroid therapy. Granulomatous mastitis should be considered in patients with treatment-resistant inflammatory breast lesions accompanied by systemic findings such as EN and arthritis. Recognition of this clinical pattern may help avoid unnecessary antibiotic use and allow timely initiation of appropriate immunosuppressive treatment.
