Breast location of tuberculosis: a case report and literature review

Abstract

Breast tuberculosis (TB) is a rare localization of extra-pulmonary TB. We report the first case observed in our daily activities to show the difficulties in the diagnosis and the good evolution in the treatment. In spite of the fact that it is rare, breast TB should not be ignored, especially in a country with high TB endemicity.

Diagnostic Challenge: A case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess

“…Tuberculosis, caused by the Mycobacterium tuberculosis bacillus 1 , 2 , is a prevalent infectious disease and a significant public health issue 3 in the South East Asian region, contributing to 46% of the global TB incidence, as estimated by the WHO 4 . TB can affect any organ of the body, but breast involvement is uncommon 5 . In fact, breast tuberculosis (BTB) is exceptionally rare, even in developing countries with high incidence of pulmonary and other extrapulmonary TB manifestations 2 , 6 .…”

“…Among these, the secondary form is more commonly observed and is usually associated with primary tubercular foci, originating from the lungs, pleura, or lymph nodes 9 , which spreads to breast tissue via lymphatic or hematogenous routes or contiguous spread from the ribs and pleural space 3 , 6 . Absence of tuberculosis lesions in other parts of the body suggests primary BTB 1 , 5 . Primary BTB occurs mostly as a lump in the central region or outer-quadrant 5 , 7 , 8 .…”

“…Absence of tuberculosis lesions in other parts of the body suggests primary BTB 1 , 5 . Primary BTB occurs mostly as a lump in the central region or outer-quadrant 5 , 7 , 8 . It always presents as a diagnostic challenge as it can frequently mimic fibroadenoma, breast abscess as well as malignancies due to nonspecific clinical presentation and inconclusive radiological investigations 2 , 5 , 9 , 11 .…”

“…BTB is a rare manifestation of tuberculosis, accounting for 0.2% of extrapulmonary TB cases 5 and 0.1–0.5% of all TB cases 10 . This unusual occurrence is thought to be attributed to the higher resistance of breast tissue against the survival and multiplication of tubercle bacilli, similar to skeletal muscle and the spleen 2 , 13 – 15 .…”

“…The various risk factors have been associated with BTB, which mainly include age, multiparity, lactation, trauma, AIDS and a past history of suppurative mastitis, along with coexisting breast carcinoma 8 , 13 , 17 . It is mostly prevalent among women of reproductive age group (21–30 years) with mean age of 29 years 5 , 6 . This could be possibly due to the frequent changes that occur in the female breast during periods of activity, making it more susceptible to trauma and infection 8 .…”