Clinical Outcomes in Initial Hirudotherapy versus Standard Treatment in Idiopathic Granulomatous Mastitis: A...

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease characterized by a high risk of recurrence and fistula formation. Spontaneous remission has been reported in up to 50% of cases, particularly in mild forms, within 6-24 months without intervention, but inadequate management may allow disease progression. The aim of this study was to compare the clinical outcomes of patients who initially preferred hirudotherapy (leech therapy) with those managed with evidence-based stepwise conventional care.

We retrospectively analyzed histopathologically confirmed IGM patients. Patients were divided into two groups: Group 1 who delayed conventional treatment for ≥6 months because they initially chose hirudotherapy, and Group 2 who received standardized stepwise management (steroids, aspiration, or surgery). Clinical outcomes included complete remission, overall recurrence/persistence, clinically significant (extensive/severe) recurrence, fistulizing/complicated recurrence, and the need for surgical intervention.

The study included 298 patients, with 41 (13.8%) in Group 1 and 257 (86.2%) in Group 2. Median delay to presentation was significantly longer in Group 1 (15 vs. 1.5 months; p<0.001). Complete remission was achieved in only 4.9% (2/41) of Group 1 compared to 59.1% (152/257) in Group 2 (p<0.001). Overall recurrence/persistence rates were 95.1% in Group 1 versus 21.8% in Group 2 (p<0.001). Among patients who experienced recurrence or persistence, clinically significant (extensive or severe) recurrence occurred in 89.7% (35/39) of Group 1 compared with 42.9% (24/56) of Group 2 (p<0.001), while fistulizing/complicated recurrence was significantly higher in Group 1 (26.8% vs. 5.4%; p<0.001). In multivariable analysis, hirudotherapy use [odds ratio (OR): 6.7; p<0.001] and fistula presence (OR: 9.3; p<0.001) were independent predictors of surgical intervention.

Initial exclusive reliance on hirudotherapy was associated with markedly lower remission rates, substantially higher rates of clinically significant recurrence, longer delays before medical evaluation, and increased surgical needs despite comparable baseline severity. These findings suggest that hirudotherapy alone does not appear to modify the immune-mediated course of IGM and may result in a higher proportion of refractory cases presenting to hospital settings, as milder cases in the community may resolve spontaneously without seeking care. Early adherence to standardized stepwise care may therefore be important to prevent progression to severe recurrence and reduce the need for surgery. However, further prospective studies are required to confirm these findings.