Tuberculosis infection of the breast mistaken for granulomatous mastitis: a case report

Abstract

Background: Tuberculosis of the breast is an uncommon disease with non-specific clinical, radiological and histological findings. Misdiagnosis is common as biopsy specimens are pauci-bacillary and investigations such as microscopy and culture are frequently negative.

Case presentation: We report a case of a breast abscess in a 34-year old Bangladeshi woman attributed to tuberculosis infection. Equivocal histology, negative Ziehl-Neelsen stain and culture for acid-fast bacilli resulted in the abscess initially being diagnosed as granulomatous mastitis and treated accordingly. However failure to respond to therapy raised suspicion of culture negative breast tuberculosis. Treatment with standard antituberculosis drugs was associated with complete resolution of the breast abscess.

Conclusion: This case highlights the difficulty in differentiating culture negative tuberculosis from granulomatous mastitis and the importance of a high index of clinical suspicion.

Figure 1

Low power field of an excision biopsy of the breast mass showing a mixed inflammatory cell infiltrate (block arrow) with suppurative granulomas (thin arrow). (haematoxylin and eosin stain; original magnification × 40).

Figure 2

High power field showing suppurative granuloma including giant cells (arrow). The granulomatous inflammation is centred on ducts and lobules (haematoxylin and eosin stain; original magnification × 200).