Idiopathic Granulomatous Mastitis in a Nulliparous Woman With Autism Spectrum Disorder Receiving Long-Term Psychotropic Treatment and Normal Serum Prolactin Level: A Case Report.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disorder, primarily attributed to immunological dysregulation, hormonal imbalances, or fertility-related conditions. We report a 26-year-old female with autism spectrum disorder (ASD) under long-term multidrug psychotropic treatment who developed IGM. She had been treated with methylphenidate for at least 23 years and aripiprazole, clozapine, citalopram, valproate sodium, and propranolol for at least 10 years. The patient was sexually inactive, had no fertility-related risk factors, and no prior use of contraceptive pills. She had no history of breast-related disorders. She presented with induration and erythema of the right breast. Ultrasound examination showed multiple organized hypoechoic collections and recommended core needle biopsy (BIRADS 4a). Pathologic evaluation revealed granulomatous mastitis, and no neoplastic lesion was identified. Her prolactin level was 17.8 ng/mL (reference range: 4.7-23.3 ng/mL). She was prescribed oral antibiotics, corticosteroids, and anti-inflammatory drugs. Due to the patient's improvement during follow-up visits, the oral corticosteroid was tapered and antibiotic therapy was discontinued. On the last visit, 5 months and 24 days after the first visit, the breast presentation exhibited complete improvement, and corticosteroid therapy was discontinued. Although a clear relationship cannot be determined from a single case, prolonged exposure to psychotropic medications may contribute to immune dysregulation and oxidative stress, potentially associated with the development of IGM.