Breast tuberculosis in immunocompetent patients at tertiary care center: A case series
A 29 year-old woman complained moderately painful pus discharge from incision site in right breast for last 3 months attended our outdoor clinic in February 2011. Incision and drainage for a lump was done at nearby hospital and treated with general antibiotics which were not responded and pus was persisted. She had last child birth 6 years earlier. No history of TB/chemotherapy of ATT was reported. She had no history of breast cancer in her family but had family history of TB to her grandfather. Mammography examination revealed a hypoechoic lesion about 0.7×0.72×0.69 cm, small rounded, with 0.18 ml volume which was noted in the inferior medial quadrant of right breast. After one month hypoechoic space occupying lesion size was increased to 1.02×0.9×0.84 cm and a volume of 0.40 ml. The patient underwent an open breast biopsy; the lump was completely excised under local anesthesia. Surgical finding was irregular cystic swelling in lower inner quadrant of right breast filed with thick and pultaceous materials communicating with lactiferous duct with surrounding fibrosis. She received intravenous augmentin 625 mg thrice daily with supplements. A sample of the pus/tissue was sent to the microbiology and histopathology laboratory. ZN microscopy, LJ culture was negative and bacterial culture and sensitivity were sterile after 48 hour of aerobic incubation. But histopathology disclosed granulomatous mastitis in breast lesion with presence of defined granulomas composed of epithelioid and multinucleated langhans giant cells. The patient was immediately placed on ATT category I regimen (2HRZE)3(4HR)3.6 After six months of follow up, wound was healed without any pus discharge and 7 kg weight gain.