Nipple discharge: An uncommon presentation of a common disease, Tuberculosis

Abstract

Sir, The incidence of tuberculosis is quite high in our country and, consequently, tuberculosis of breast may be frequent enough but possibly overlooked or misdiagnosed as carcinoma or pyogenic abscess. [1] The most common mode of spread to the breast is lymphatic and hematogenous, although spread from contagious structures, direct inoculation and ductal infection are other rare modes of spread of this disease. [2] Tubercular mastitis can present as nodulocaseous, disseminated and breast abscess. [2] Moreover, superadded bacterial infection further causes misdiagnosis of this disease as pyogenic abscess. Acid fast bacilli (AFB) microscopy and culture is considered as the gold standard for the diagnosis of tuberculosis, although paucibacillary specimens and time required for culture are important limitations. Fine needle aspiration has also been advocated as an important diagnostic tool in breast tuberculosis, but secondary bacterial infection can often be misleading. [1] The advent of newer diagnostic techniques such as automated mycobacterial growth systems (BACTEC) and nucleic acid amplification have been explored as time saving and sensitive techniques. The management of this disease depends on sound diagnosis and anti‑tubercular therapy, with surgery having a minimal role. [1,3]