Tubercular Mastitis Mimicking as Malignancy: A Case Report

Diagnostic challenge: a case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess

Introduction

Breast tuberculosis (BTB) is a rare form of extrapulmonary tuberculosis with its primary form considered even rarer.

Case presentation

A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary BTB, necessitating antitubercular therapy.

Clinical discussion

BTB, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, persistent symptoms despite treatment should prompt consideration of BTB in TB endemic regions.

Conclusion

Primary BTB might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.

Idiopathic Granulomatous Lobular Mastitis: An Imitation of Breast Carcinoma

Since idiopathic granulomatous lobular mastitis, also known as idiopathic granulomatous mastitis or granulomatous lobulitis, was first described by Kessler and Wolloch in 1972, no consensus on the ideal and definitive treatment for this phenomenon has been reached thus far. Idiopathic granulomatous lobular mastitis mostly frequently observed in women of childbearing age within a few years of pregnancy with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. This entity, per se, is a rare, benign, chronic inflammatory breast condition of unknown aetiology mimicking two common breast disorders. The first is breast inflammations or infection, such as cystic neutrophilic granulomatous mastitis; granulomatous mastitis due to Corynebacterium;other infections with granulomas, mycobacteria, fungi, cat scratch disease, and Brucella; granulomatosis with polyangiitis (Wegener's granulomatosis); sarcoidosis; and squamous metaplasia of lactiferous ducts. The second is breast carcinoma in some challenging cases. Of note, no consensus, per se, has been declared on its therapeutic management. The following vignette case described in this report involves idiopathic granulomatous lobular mastitis imitating breast carcinoma. It is important to note that, the aetiology of idiopathic granulomatous lobular mastitis is unknown, its diagnosis is difficult, and physicians should be vigilant and aware of this condition in order of abstaining from an overtreatment for malignancy or overlooking a true malignancy.