Tubercular Mastitis in Men: Case Report and Systematic Review

Abstract

Background Tuberculous mastitis is usually reported in multiparous postpartum women and is an unusual cause of gynecomastia in adolescent men. Methods We describe an illustrative case and review all cases of tubercular mastitis reported in men in the English literature. Results Our search yielded 24 cases of male tubercular mastitis. Most presented with an isolated breast lump. Constitutional symptoms were rare (21.4%), and associated tuberculosis foci, mostly inactive, were seen in 43.8%. Breast parenchymal involvement, chest wall masses, pectoral muscle abscesses, cold abscesses tracking through the chest wall, and empyema necessitatis presented as breast lumps. Fine-needle aspiration cytology was the most common diagnostic modality, and acid-fast bacilli were demonstrable in a minority (33%). A combination of granulomatous mastitis, necrosis, and clinical response to antitubercular therapy was the most common mode of establishing the diagnosis. Most patients responded to antitubercular therapy alone. Conclusion Tubercular mastitis is a rare cause of breast masses in men, and a high index of suspicion can prevent diagnostic delays. Most patients respond to antitubercular therapy alone.