International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases | 2021
Etiology of granulomatous lobular mastitis based on metagenomic Next-Generation Sequencing.
Abstract
OBJECTIVES\nWe aimed to explore the etiology of granulomatous lobular mastitis (GLM) comprehensively, so as to optimize treatment programmes.\n\n\nMETHODS\n30 fresh mastitis samples were collected for metagenimic Next-Generation Sequencing (mNGS), morphological observation, and analysis of the clinical information.\n\n\nRESULTS\n25 of 30 samples were GLM, and pathogens were detected in 17 of them included Corynebacterium kroppenstedtii (10/25, 40%), Corynebacterium kroppenstedtii and Pseudomonas oleovorans (3/25, 12%), Corynebacterium kroppenstedtii and Human gammaherpesvirus 4 (1/25, 4%), Acinetobacter baumannii and Corynebacterium kroppenstedtii (1/25, 4%), Pseudomonas oleovorans (1/25, 4%), Tepidiphilus thermophilus (1/25, 4%). 12 of 25 samples had abnormal sex hormones level (mainly prolactin) and/or autoimmune function. Besides, lipophilic antibiotics (rifampicin) work effectively in the patients with long-healing wound after surgery.\n\n\nCONCLUSIONS\nThe main pathogenic factors of GLM is Corynebacterium kroppenstedtii infection, but other unusual pathogens (such as Pseudomonas oleovorans, Human gammaherpesvirus 4, Acinetobacter baumannii, Tepidiphilus thermophilus) are likely to be closely related to GLM, especially Human gammaherpesvirus 4 (EBV)-associated mastitis may be a new entiy of mastitis. Abnormal levels of sex hormones and autoimmune are also common causes. Thus, lipophilic antibiotics (rifampicin) and prolactin inhibitor may be an effective medicine.