Case Series of Primary Breast Tuberculosis Presenting as a Lump: A Diagnostic Challenge

Abstract

Tuberculosis of the breast is rare, even in countries where the disease is endemic. Breast tuberculosis usually occurs secondary to infection elsewhere. Less commonly, it may be the primary site with no demonstrable focus elsewhere. It is mainly encountered in immunosuppressed individuals, those with a history of trauma and suppurative mastitis. It commonly presents as a lump in the breast, but other presentations such as breast abscess, dull aching pain, nipple discharge, etc., have been reported. Multiparous and lactating women in their second to fourth decade are commonly affected. Studies have shown that microbiological diagnosis is limited to a few cases, and histopathology is the mainstay in diagnosing cases of breast tuberculosis. In the present case series, two cases (44-year-old and 40-year-old females) presented with a painless, ill-defined lump in the left breast. Another case (33- year-old female) presented with a lump in the left breast with dull aching pain. Constitutional symptoms were absent in all of the present case series patients. Microbiological positivity in the form of Cartridge-based Nucleic Acid Amplification Test (CBNAAT) positivity was seen in only one of the patients. Biopsy of all these cases showed non caseating granuloma. All the patients had primary breast tuberculosis with no other organ involvement. All the patients were started on standard antitubercular therapy with a fixed drug combination, following an initial delay due to the non caseating nature of the granuloma. All of them responded well to the therapy. The present case series compared the characteristics and delved deeply into the current data and research on breast tuberculosis to understand the same.