Breast tuberculosis in immunocompetent patients at tertiary care center: A case series
A 40-year-old female was referred to our centre for management of left breast pain with purulent discharge in April 2010. There was no history of recent pregnancy or lactation or a history of breast trauma. She had noticed a painful mass in her left breast one year ago. Again from last 20 days she noticed a visible skin lesion on the breast with purulent discharge. She had no history of previous ATT intake, tubercular infection in her family, diabetic mellitus (DM) and weight loss or fever. She received at least 3 courses of antibiotic therapy by local physician but no therapeutic effect was noticed before she was referred to our centre. On physical examination, a painful nodular mass was detected near to the nipple of the left breast along with a discharging sinus. Based on the ultrasonography and mammography results, the patient underwent FNAC with a suspicion of malignancy/TB or any pyogenic infection. Diagnostic FNAC smear showed group of epithelioid cell and multinucleated histolytic giant cell on a background of mixed inflammatory cell infiltrate composed of neutrophilic polymorphs lymphocyte and histocytes in conjunction with positive AFB in pathology. AFB was also positive by ZN satin in microbiology. Mycobacterium culture was positive after 3 weeks incubation. Interferon gamma releases assay in tube (IGRA-IT) was positive. Chest radiography was intact and there were no changes compatible with TB or sarcoidosis. On the basis of laboratory evidence, the patient was put on standard four ATT category I regimen (2HRZE)3(4HR)3.[] The discharge was stopped and a healed sinus tract was seen after three months subsequent follow-up.