Our Eyes Can See Only What the Mind Knows: A Rare Case of Tuberculosis of Breast

Abstract

Tuberculous mastitis is an infrequent clinical entity. It appears mostly in women of reproductive age. We report a case of 25-year-old female presenting with complaints of cough, weight loss and intermittent episodes of fever for last 6 months. She also gave history of pain and sense of heaviness in the right breast along with discharge for last 1 month. On general physical examination, no abnormality was detected except pallor. Examination of the right breast revealed an ill-defined, irregular, firm lump (15×12 cm), adherent to the breast tissue. Ultrasonography guided aspiration of pleural fluid and pus from breast abscess was done and sent for microbiological analysis. Acid fast bacilli were detected on microscopy of pleural fluid and aspirated pus. Mycobacterium tuberculosis was identified in both samples by using line-probe assay (GenoType MTBDRplus). RpoB gene was absent in both the samples. She gradually improved over one month of anti-tubercular treatment. This disease can present with a diagnostic dilemma on radiological and microbiological investigations and thus a high index of suspicion is essential as demonstration of Acid Fast Bacilli (AFB) from the lesions is usually difficult. Incorporating a highly sensitive technique like Polymerase Chain Reaction (PCR), Line Probe Assay (LPA) may be helpful in establishing the usefulness of such technology and can aid in confirming diagnosis early.