Recurrent Sterile Breast Abscesses – A Diagnostic Pursuit: A Case of Idiopathic Granulomatous Mastitis

Abstract Introduction: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that frequently mimics carcinoma or tubercular mastitis, particularly in endemic regions like India. This diagnostic overlap often complicates management, leading to unnecessary surgical interventions or empirical anti-tubercular therapy. Case Presentation: We report the case of a 28-year-old female presenting with recurrent, sterile abscesses of the right breast. Despite multiple incisions and drainage procedures, pus cultures and extensive molecular tuberculosis (TB) workups (TruNAT/ AFB) remained consistently negative. Definitive diagnosis was achieved through repeat surgical biopsies, which revealed non- caseating granulomas consistent with IGM. Management and Conclusion: Following the rigorous exclusion of tuberculosis and malignancy, the patient was treated with doxycycline (100 mg BD). She demonstrated significant clinical recovery with reduced inflammation and no further recurrence. This case underscores the necessity of diagnostic persistence, utilizing molecular assays and multiple biopsies, to rule out TB, and highlights doxycycline as a viable, effective alternative to corticosteroid therapy. Key words: Doxycycline, Idiopathic granulomatous mastitis, Non-caseating granuloma, Sterile abscess, TruNAT