Tuberculosis of the Breast: A Case Report

Abstract

INTRODUCTION: Tuberculosis of the breast is a rare condition, with an incidence ranging from 0. 1% to 0.52% even in countries where the case rate of tuberculosis is high1. It affects virtually only women, particularly those aged 20 to 50 years, and occurs more commonly in blacks than in whites. Similar to the skeletal muscle and spleen, breast tissue seems to be resistant to Mycobacterium tuberculosis, which may justify the low incidence of disease in these sites2. Microbiologic and histopathologic tests are the gold standard for diagnosis of breast tuberculosis, by identifying acid-fast bacilli (AFB) and granuloma with caseation necrosis and histiocytic inflammatory infiltration, respectively4. We report a case of breast tuberculosis in a female patient. CASE REPORT: A 76-year old female patient sought the breast disorder service due to the appearance of a red patch and increased volume of the left breast for two months. She had no fever and reported drainage of purulent secretion with fistulous orifices. On physical examination, the patient presented with a bloodstained area measuring 6x6cm at the junction of the upper quadrants of the left breast, with fistulizing and necrotic areas surrounding the main lesion. The patient was gravida 0, para 0 and had a positive history of smoking, hypertension and Alzheimer’s disease. History of alcoholism and diabetes was negative. Chest tomography was normal and PPD test was negative. Histopathologic analysis of the lesion showed a chronic granulomatous inflammatory process, with foci of necrosis, although not caseous necrosis. Cephalexin, ciprofloxacin and anti-inflammatory drugs had been administered to the patient but treatment was unsuccessful. The option was a therapeutic test for tuberculosis, since clinical presentation of the lesion was suggestive of tuberculosis. Antituberculous therapy was begun with ethambutol, 275mg/d; rifampin, 150mg/d; and isoniazid, 75mg/d, 3 pills daily. There was a good clinical response with resolution of the breast lesion and complete wound healing. At one-year follow-up, the patient remains well and has no further lesions or complaints. DISCUSSION: Despite being a rare infection, tuberculosis of the breast should always be considered in patients presenting with a palpable breast lump or fistulizing inflammatory process, who test negative for malignancy. Histopathologic evaluation is essential for diagnostic confirmation. Furthermore, in the absence of a histologic diagnosis, a therapeutic test may be necessary, as occurred in the present case.