A rare extrapulmonary presentation of tuberculosis: Breast tuberculosis

Key Clinical Message

Breast abscess of long duration can be tubercular origin in both developing and developed countries despite its rarity.

Abstract

A 34-year-old lady presented with painful lump on her breast for 2 months, which was diagnosed with mammary tuberculosis on basis of aspiration cytology and successfully treated with antitubercular drugs. Breast abscess of long duration may be tubercular etiology in both developing and developed nations.

Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital

BACKGROUND

Granulomatous mastitis (GM) is a rare inflammatory disease of the breast. Tuberculosis mastitis (TM), one of the causes of GM, is a rare form of extrapulmonary tuberculosis. The clinical, radiological, and histopathological findings of TM and GM are similar, and sometimes it is difficult to make a distinction between these disease states. In this study, we aimed to evaluate the clinical and radiological features, diagnostic techniques, treatment modalities and treatment outcomes of the patients with GM and TM.

METHODS

The data of the patients with confirmed GM by histopathologic examination of biopsy specimens between 2007 and 2020 were retrospectively analyzed. Demographic features, main complaints, physical findings, radiological and laboratory data, treatment modalities, and treatment outcomes were recorded.

RESULTS

Sixty-eight GM patients with a mean age of 35.8 (18-63) years were evaluated. The patients had a mass lesion, pain, ulceration,and abscess in their breasts. All of the cases were female. Ultrasonographic examinations were performed on 62 cases. Abscess and/or sinus tract formation was detected in 34, heterogeneous hypoechoic mass in 15, heterogeneous parenchyma or parenchymal edema in 15, axillary lymphadenopathy in 18 and cysts in 13 patients. A total of 10 patients were lost to follow-up. Twenty-six patients underwent surgery for their breast lesions or had antibiotherapy (n = 13) or corticosteroid therapy (n = 7). Eleven (16.1%) patients were diagnosed with TM. These patients were evaluated by clinical examination, chest radiography, and tuberculin skin test. Acid-fast bacilli (AFB) staining and culture were negative in all cases. The diagnosis of TM was based on histopathological evaluation results. Eight of the 11 patients achieved complete remission with antituberculosis treatment.

DISCUSSION

The etiological diagnosis of GM must be based on a multidisciplinary approach. Tuberculosis mastitis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis.

Breast Tuberculosis: A Case Report

Breast tuberculosis (BTB) is a rare manifestation of tuberculosis (TB), and it is more common in countries with a high incidence of TB. We describe a case of a 36-year-old Angolan woman, who had a history of breast reduction surgery, presenting with right breast enlargement, pain, purulent discharge through multiple skin openings, fever, and abdominal pain, progressively worsening in the past year. She had already undergone several surgical drainages and six months of treatment with ciprofloxacin, with no improvement. Breast ultrasound and MRI were performed, which revealed a large fluid collection, with several small abscesses and surrounding adenopathies, complicated by multiple fistulae. The fluid was drained through needle aspiration, which was found to be sterile for bacteria, mycobacteria, and fungi. A lymph node biopsy showed necrosis without granulomas, and the biopsy culture was positive for Mycobacterium tuberculosis (Mt). This case shows how a rare manifestation can simulate bacterial breast abscesses or cancer, and hence a high index of suspicion is necessary to reach the correct diagnosis and ensure appropriate treatment delivery in these patients.

Primary breast tuberculosis in an HIV-infected patient

The presentation of tuberculosis can be nonspecific and atypical in patients with human immunodeficiency virus infection, especially in the extrapulmonary forms. The incidence of breast tuberculosis is very low. We report a case of primary breast tuberculosis: a 26-year-old woman with a 5-month history of a left-sided breast lump associated with pain. Biopsy of the breast lump for histological examination suggested granulomatous inflammation, secretions tested with GeneXpert for Mycobacterium tuberculosis were positive, and no evidence of tuberculosis was found in other organs. She was treated with incision, drainage, dressing, and 6 months of anti-tuberculosis treatment; her prognosis was good.

An unusual presentation of breast tuberculosis: A case report

Primary breast tuberculosis is an uncommon disease, especially in nonendemic areas. Its presentation could mimic a cancer or an abscess, but this entity must be considered for differential diagnosis in women coming from endemic countries.

Features of breast tuberculosis determined by ultrasound imaging: report of 45 cases

Objective

This study aimed to characterize the ultrasound (US) imaging features of breast tuberculosis (BTB) to clarify the process of disease progression and provide valuable clinical information.

Methods

We retrospectively reviewed 45 patients with pathologically or GeneXpert-confirmed BTB from January 2010 to December 2017. We assessed the US features of target lesions including size, shape, orientation, margin, echogenicity, calcification, posterior acoustic features, and blood-flow signal.

Results

The patients were classified with nodular (55.5%, 25/45), abscess (15.6%, 7/45), or sinus (28.9%, 13/45) type according to their US features. Forty lesions (88.9%, 40/45) extended in a parallel orientation and five extended in a non-parallel orientation. Calcifications were found in eight cases, including six macrocalcifications and two microcalcifications. Enlarged axillary lymph nodes were observed in three cases (6.7%, 3/45). In addition, 44 of the 45 cases (97.8%, 44/45) exhibited hypovascularity or avascularity according to color Doppler flow imaging (CDFI).

Conclusion

BTB lesions can be classified as nodular, abscess, or sinus type according to their US imaging features. Poor blood supply detected by CDFI might be a common US feature of BTB. Characterization of its US features may facilitate the clinical diagnosis of BTB.

Breast tuberculosis: A case report of primary type mammary tuberculosis

Mammary tuberculosis is exceptional in developed countries. It can mimic an abscess or a granulomatous mastitis. In subjects coming from endemic areas, it is necessary to suspect a tuberculosis infection in case of recurrent mastitis refractory to antibiotics. Positivity of Quantiferon-TB Gold assay can help to confirm the clinical suspicion.

The T-SPOT.TB Test for Diagnosis of Breast Tuberculosis

OBJECTIVE

To assess the diagnostic value of the T-SPOT.TB test in cases of breast turberculosis (BTB) in China.

METHODS

We enrolled 13 female patients with primary BTB as the BTB test group and 10 healthy volunteers as the control group. The 2 groups underwent T-SPOT.TB tests and tuberculin skin tests (TSTs) before receiving a core-needle biopsy or excision biopsy. We then collected and analyzed T-SPOT.TB and TST data.

RESULTS

The sensitivity of the T-SPOT.TB test for detection of BTB (84.6%) was significantly greater than that of TST (53.8%) (P <.05); the specificity of each test (80.0% and 60.0%, respectively) for BTB was not significantly different (P >.05).

CONCLUSION

The T-SPOT.TB test could be a useful adjunct to current tests for diagnosis of BTB and could be used for early diagnosis of this condition.